Chapter – II

REVIEW OF RELATED LITERATURE

The review of related literature is instrumental in the selection of the topic
formation of hypothesis and deductive reasoning, leading to the problem. The literature in
any field forms the foundation upon which all future work will be built. Collection of
relevant literature provides the basic understanding of the problems and its depth. Such
reviews bring about a deep insight and a clear perspective of the overall field.
“A study of relevant literature is an essential step to get a full picture of what has
been done with regards to the problem under study”. Such a review brings about a deep
and clear perspective of the overall field. (Thirumalaisamy, 1985).
The purpose of the study was to find out the effect of selected physical activities
on the selected gross motor skills of children with Down syndrome. In order to facilitate
such study, the knowledge and construction of similar work be becomes essential. A
study of relevant literature is an essential step to get a good comprehension of what has
made an honest and sincere attempt to locate the similar studies made by various
scholars. Through Internet, textbook, magazine, journals, research quarterlies and
dissertation abstracts.
Such collected references have been presented in logical order of important and
sequence of merit in this chapter several excellent research reviews on various aspects of
physical education and sports have been published so far. If any one or more can be
found on the present study it can be an excellent starting point for literature search. Such
reviews are the second sources abstracts or synthesized by the researcher. A discussion
of the related work would always help the investigator in finding his direction of the
study.
Literature survey has served as a guideline to identify the general trends in the area
of test and measurement. Studies have been conducted related to the present area levels.
The salient aspects related to this study are briefly discussed below under suitable
heading.
 Lotan M., (2007) intervened the Quality physical intervention activity for persons
with Down syndrome. Persons with Down syndrome (DS) are at risk for a life of
inactivity that can result in a multitude of medical problems including heart and vascular
diseases. This review presents findings regarding the physical status of individuals with
DS, as well as proper interventions found to improve the physical fitness and general
health for this population. This review was written with the intent to suggest practical
directions in planning and implementing quality physical intervention programs for this
population.

Vicari S., (2006) studied the Motor development and neuropsychological patterns
in persons with Down syndrome. Neuropsychological research has permitted defining
specific cognitive profiles among individuals with mental retardation (MR) of different
etiology. Namely, the cognitive profile of people with Down syndrome (DS) is often
reported to be characterized by a deficit in language abilities that usually exceed
impairments in visual-spatial capacities. However, recent studies have demonstrated a
more complex neuropsychological profile in this population, with atypical development
in the cognitive and in the linguistic domain. This paper is dedicated to reviewing
literature regarding motor, linguistic and cognitive abilities in DS. Individuals with these
syndrome exhibit a peculiar motor development and neuropsychological profile with
some abilities more preserved et al., more impaired. This finding may have theoretical
and practical implications. In fact, a better definition of the cognitive pattern in DS may
contribute to understand the nature of MR in general and, also, it may suggest
individualized rehabilitation treatment protocols.

Dan Gordon (2006) studied on the benefits of exercise to a Down’s syndrome

population. The benefits of exercise and training for a reference population are well
understood and the merits well documented. The aim of this review is to ascertain the
benefits of exercise for a Down's syndrome population. The physiological characteristics
of the Down's syndrome individual exhibit potential limitations and restrictions to both
cardiovascular and resistance based exercise, with poor skeletal muscle development and
chronotropic incompetence being the primary constraints. The merits to the Down's
syndrome individual are clear with many being classed as obese and showing classic
signs of the contraindications to exercise. There is limited data available as to the
physiological responses to exercise and training, but those presented highlight both
benefits in terms of the physiological responses and inconsistencies in terms of methods
applied. The physiological responses in terms of cardiovascular (CV) and bi-motor
abilities are explored and examined showing that a key stimulus for adaptation are the
ground impact forces (GIF). An overriding factor that affects all of the presented
outcomes is the adherence of the individual to the program, with drop out rates greater
than 50% in six months being reported.

The conclusion would appear to be that a program is developed which is

structured, and stimulating and conforms to the needs of the Down's Syndrome
individual, taking into account their specific physiological needs.

Sanyer ON., (2006) conducted a study on Down syndrome and sport

participation. Individuals with Down syndrome (DS) derive measurable physiologic and
psychologic benefits from participation in physical activities and sports. Physicians in the
position of evaluating these individuals and providing guidance in regard to their
competitive or recreational physical activities need to be aware of the physiologic and
anatomic concerns specific to this population. Effective screening and evaluation by a
physician, accompanied with clearly communicated guidelines for specific activities, can
provide an individual with DS the opportunity to safely participate in sports and
recreational physical activity.

Seif Eldin AG., (2005) investigated the Swimming programme for mentally
retarded children and its impact on skills development; People with Down syndrome
suffer from many social, psychological and motor function problems. Current research
has looked at swimming programmes to assess their impact on such problems. The
programme described here was applied for a 3-month period, with music being used as
one of the tools. The results were very positive and children showed significant
improvement in agility, self-esteem and behaviour patterns. The programme is thus
effective in enhancing the integrated development of children with Down syndrome.

Ulrich DA et al.,(2001) programmed the Treadmill training of infants with Down

syndrome: Evidence-based developmental outcomes OBJECTIVE: On average, infants
with Down syndrome (DS) learn to walk about 1 year later than nondisabled (ND)
infants. The purpose of this study was to determine if practice stepping on a motorized
treadmill could help reduce the delay in walking onset normally experienced by these
infants. METHODS: Thirty families of infants with DS were randomly assigned to the
intervention or control group. All infants were karyotyped trisomy 21 and began
participation in the study when they could sit alone for 30 seconds (Bayley Scales of
Infant Development, Second Edition 1993, item 34). Infants received traditional physical
therapy at least every other week. In addition, intervention infants received practice
stepping on a small, motorized treadmill, 5 days per week, for 8 minutes a day, in their
own homes. Parents were trained to support their infants on these specially engineered
miniature treadmills. Every 2 weeks research staff went into the homes and tested infants'
overall motor progress by administering the Bayley Scales of Infant Development,
Second Edition, monitored growth status via a battery of 11 anthropometric measures,
and checked parents' compliance with physical therapy and treadmill intervention. The
primary measures of the intervention's effectiveness were comparisons between the
groups on the length of time elapsed between sitting for 30 seconds (entry into the study)
and 1) raising self to stand; 2) walking with help; and 3) walking independently.
RESULTS: The experimental group learned to walk with help and to walk independently
significantly faster (73.8 days and 101 days, respectively) than the control group, both of
which also produced large effect size statistics for the group differences. The groups were
not statistically different for rate of learning to raise self to stand but there was a
moderate effect size statistic suggesting that the groups were meaningfully different in
favor of the experimental group. CONCLUSIONS: These results provide evidence that,
with training and support, parents can use these treadmills in their homes to help their
infants with DS learn to walk earlier than they normally would. Current research is aimed
at 1) improving the protocol to maximize outcome; 2) determining the impact of
treadmill practice on walking gait patterns; 3) testing the application to other populations
with a history of delays in walking; and 4) determining the long-term benefits that may
accrue from this form of activity.

Angulo-Barroso R et al., (2008) observed the Physical activity in infants with

Down syndrome receiving a treadmill intervention. Despite the recognized relevance of
physical activity in the development and health of children, assessment of physical
activity levels (PA-level) in infancy is limited, especially in infants with Down
syndrome (DS). Increasing PA-level using a treadmill training (TMT) intervention may
benefit infants with motor delays. The purpose of this study was to investigate whether
a higher intensity, individualized TMT protocol (HI) would elicit immediate and short-
term higher PA-level in infants with DS than a lower intensity, generalized training
protocol (LG). Thirty infants with DS were randomly assigned to the LG or the HI
group. Training was terminated when the infants could walk three steps independently.
Activity monitors were placed on infants' trunks and legs for a 24-h period every other
month during the intervention phase, and at set intervals 1-year post-independent
walking onset. Data were analyzed to separate sedentary-to-light activity (Low act) and
moderate-to-vigorous activity (High act). Overall our results demonstrate that infants
receiving the HI TMT had higher levels of High act than infants in the LG group,
factoring out the activity produced by the intervention itself. Infants in the LG group
spent more time in Low act than the HI group. In addition, these results seemed to be
retained during the post-intervention follow-up. Despite these exciting results, more
work is needed to understand the relationship of the intensity of TMT on PA-level in
infants with DS, and whether PA-level and TMT are related to motor milestone
achievement and/or health benefits.
 Dodd KJ and Shields N., (2005) studied the systematic review of the outcomes of
cardiovascular exercise programs for people with Down syndrome. To determine if
cardiovascular exercise programs are beneficial and safe for people with Down
syndrome. DATA SOURCES: Electronic databases were searched from the earliest
time available through to October 2004 using the following key words: Down syndrome
or trisomy 21 in combination with physical fitness, exercise, physical activity, exercise
therapy, exercise training, physical training, and aerobic. Additional articles were
identified by manual searching and citation tracking. STUDY SELECTION: Two
reviewers independently assessed the articles identified in the initial search for the
following inclusion criteria: (1) participants with Down syndrome, (2) an exercise
program that conformed with the American College of Sports Medicine guidelines for
increasing cardiovascular fitness, (3) assessed changes in body structure or function,
activity limitation, or societal participation, and (4) used a prospective clinical
controlled research design with or without random allocation to groups. Trials of low
methodologic quality were excluded (PEDro score, <4). Of the 156 articles initially
identified, only 4 met the inclusion criteria and underwent detailed review. DATA
EXTRACTION: Data relating to changes in body structure and function, activity
limitation, participation restriction, and contextual factors from the included studies
were independently extracted by the reviewers on a standardized form. Study quality
was assessed using the PEDro scale. DATA SYNTHESIS: Meta-analyses found that
cardiovascular exercise programs were effective in increasing peak oxygen
consumption (d=.75; 95% confidence interval [CI], 0.34-1.15), peak minute ventilation
(d=.71; 95% CI, 0.15-1.28), the maximum workload achieved (d=.96; 95% CI, 0.45-
1.45), and the time to exhaustion (d=.72; 95% CI, 0.29-1.15) in people with Down
syndrome. No changes were found for body weight (d=.09; 95% CI, -.39 to .57). No
adverse effects were reported in any of the studies. CONCLUSIONS: The result of our
review support the use of programs designed to improve cardiovascular fitness among
people with Down syndrome. However, because only 4 studies were included, the
findings need to be interpreted cautiously. High-quality randomized controlled trials
should be completed in the future to determine the effect of these programs on activity
and social participation

Andriolo RB et al., (2005) conducted a study on Aerobic exercise training

programmes for improving physical and psychosocial health in adults with Down
syndrome. Although physical fitness has been suggested to improve physical and
psychosocial health for a variety of population profiles, there is a lack of information
about the safety and effectiveness of aerobic exercise for adults with Down syndrome.
OBJECTIVES: To evaluate the effectiveness and safety of aerobic exercise training
programmes for physiological and psychosocial outcomes in adults with Down
syndrome. SEARCH STRATEGY: Search terms and synonyms for "aerobic exercise"
and "Down syndrome" were used within the following databases:CENTRAL (2005,
Issue 2); MEDLINE (1966 to March 2005); EMBASE (2005 to April 2005); CINAHL
(1982 to March 2005); LILACS (1982 to March 2005); PsycINFO (1887 to March
2005); ERIC (1966 to March 2005); CCT (March 2005); Academic Search Elite (to
March 2005), C2- SPECTR (to March 2005 ), NRR (2005 Issue 1), ClinicalTrials.gov
(accessed March 2005)and within supplements of Medicine and Science in Sports and
Exercise. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials
using supervised aerobic exercise training programmes with behavioral components
accepted as co-interventions. DATA COLLECTION AND ANALYSIS: Two reviewers
selected relevant trials, assessed methodological quality and extracted data. Where
appropriate, data was pooled using meta-analysis with a random effects model MAIN
RESULTS: The two studies included in this trial used different kinds of aerobic
activity: walking/jogging and rowing training. One included study was conducted in the
USA, the other in Portugal. In the meta-analyses, only maximal treadmill grade, a work
performance variable, was improved in the intervention group after aerobic exercise
training programmes (-4.26 [95% CI -6.45, -2.06]) grade. The other outcomes in the
meta-analysis showed no significant differences between intervention and control
groups, as expressed by weighted mean difference: VO(2) peak -0.30 (95% CI -377,
3.17) mL.Kg.min(-1); peak heart rate, -2.84 (95% CI -10.73, 5.05) bpm; respiratory
exchange ratio, 0.01 (95% CI -0.04, 0.06); pulmonary ventilation, -5.86 (95% CI -16.06,
4.34) L.min(-1). 30 other measures including work performance, oxidative stress and
body composition variables could not be combined in the meta-analysis. Trials reported
no significant improvements in these measures. AUTHORS' CONCLUSIONS: There is
insufficient evidence to support improvement in physical or psychosocial outcomes of
aerobic exercise in adults with Down syndrome. Although evidence exists which
supports improvements in physiological and psychological aspects from strategies using
mixed physical activity programmes, well-conducted research which examines long-
term physical outcomes, adverse effects, psychosocial outcomes and costs are required
before informed practice decisions can be made.

Barnhart RC and Connolly B., (2007) intervened on Aging and Down

syndrome: implications for physical therapy. The number of people over the age of 60
years with lifelong developmental delays is predicted to double by 2030. Down
syndrome (DS) is the most frequent chromosomal cause of developmental delays. As
the life expectancy of people with DS increases, changes in body function and structure
secondary to aging have the potential to lead to activity limitations and participation
restrictions for this population. The purpose of this update is to: (1) provide an overview
of the common body function and structure changes that occur in adults with DS as they
age (thyroid dysfunction, cardiovascular disorders, obesity, musculoskeletal disorders,
Alzheimer disease, depression) and (2) apply current research on exercise to the
prevention of activity limitations and participation restrictions. As individuals with DS
age, a shift in emphasis from disability prevention to the prevention of conditions that
lead to activity and participation limitations must occur. Exercise programs appear to
have potential to positively affect the overall health of adults with DS, thereby
increasing the quality of life and years of healthy life for these individuals.
 Kokubun M et al., (1995) Factors affecting age of walking by children with
mental retardation. The relationship between age of walking and two factors of severity
of intellectual disability and clinical types (autism, Down syndrome, epilepsy, and
"residual") in children with mental retardation was investigated. Subjects were 118
children whose disabilities ranged from severe to mild. Measures by clinical type were
significant, and the differences of any two clinical types except between children with
epilepsy and the "residual" group were significant, but severity of intellectual disability
was not significant. Most children with autism (27 subjects, 93%) walked by the normal
time limit of 18 months. Only 3 children (11%) with Down syndrome began to walk
within that limit, and 9 of them (33%) walked after 2 years of age. In the "residual"
group (including children with epilepsy), 37 children (60%) walked within the normal
limit but 15 (25%) only after 2 years of age.

Cremers MJ et al., (1993) studied the Risk of sports activities in children with
Down's syndrome and atlanto axial instability. 10-40% of children with Down's
syndrome have atlantoaxial instability. These children might run the risk of spinal cord
compression if they play sport. The aim of our study was to assess this presumed risk.
We obtained 282 radiographs of the cervical spine from a cohort of 400 children and
young adults with Down's syndrome who attended special schools and who were
between 4 and 20 years old (about 25% of all such children in the Netherlands). The
atlantoaxial distance was more than 4 mm in 91 children. These children were randomly
assigned to two groups, with the provision that all children at any particular school were
assigned to the same group. Children of one group were allowed to continue their
habitual sports and exercise activities, whereas those in the other group were advised
not to play "risky" sports (as defined by a panel of four experts) and not to make "risky"
movements during physical education lessons. The compliance of the experimental
group was good. After a year, there were no differences between the groups in scores on
a functional motor scale, the frequency of neurological signs, or changes in the
atlantoaxial distance. The motor function of a third group of 44 children with Down's
syndrome but normal atlantoaxial distances was similar to that of children in the other
two groups, as was the frequency of neurological signs. These findings suggest there is
no reason to stop children with Down's syndrome from playing certain sports and no
need to screen them by radiography before they take up such sports activities.

Sharav T and Bowman T. (1992) conducted a study on Dietary practices,

physical activity, and body-mass index in a selected population of Down syndrome
children and their siblings. Thirty sibling pairs, each with one Down syndrome child
between the ages of 2 and 14, were selected from families who had participated in an
infant-stimulation program. The maternal and paternal educational levels were 14.9 and
16.9 years, respectively. The Down syndrome patients and their siblings were compared
in terms of body-mass index, that is, weight/stature2 (w/s2); activity as measured on a
questionnaire; and weekly caloric intake. There were no significant differences between
the Down syndrome children and their siblings in terms of w/s2. The Down syndrome
patients were less active than their siblings and spent significantly more time indoors,
showing a preference for indoor activities. Caloric intake calculated as percentage of
recommended allowance for height was somewhat less in the Down syndrome children-
-88.7%, compared with 95% in the siblings--but not significantly so. It is postulated that
even though Down syndrome patients have been shown to be at risk for obesity, familial
and other environmental factors, such as dietary control and involvement in physical
activity, have an influence.

Kanode JO and Payne VG. (1989) undertook a study to evaluate the effects of
variable practice on retention and motor schema development in Down syndrome
subjects. Portions of Schmidt's schema theory, the effects of variable practice on
retention and ability to learn a novel motor task, were tested using Down syndrome
subjects. 23 subjects ranged in mental and chronological ages from 3.0 to 5.1 yr. and 4.6
to 22 yr., respectively. IQs ranged from 32 to 62. The two throwing tasks were closed,
discrete movements requiring no feedback or error detection during movement. Subjects
were randomly assigned to a specific-practice, variable-practice, or control group.
Specific group subjects practiced 100 trials from the test-target location. Variable-
practice subjects also practiced 100 trials but from four different practice locations. The
control group practiced an unrelated kicking activity. All subjects participated in
identical pre-tests, post-tests, and retention tests to assess accuracy on these throwing
tasks. A standard archery target was used to score tosses. To examine the effects of
practice on a novel task, two target conditions, or tasks, were employed. On Task A the
subject tossed a bean bag at the archery target placed flat on the floor. For Task B, the
novel task, the target was placed upright on the wall. Subjects were assigned higher
scores for tosses landing closer to the center of the target. Analysis of variance indicated
no significant differences between groups on Task A pretest or posttest. Significance
was detected for the main effect of group for Task B. However, the Scheffé post hoc test
indicated that the simple main effects were no significant. This research did not support
Schmidt's schema theory

Stratford B and Ching EY. (1989) conducted a study on Responses to music and
movement in the development of children with Down's syndrome. Physical responses to
rhythmic stimuli and music, of different degrees of complexity were registered from 25
children with Down's syndrome and 25 other mentally handicapped children. Required
performances were taught and then recorded on video-tape, after which they were
assessed by experienced teacher/judges. Whilst there were no overall significant
differences between the groups, important differences were detected between the
children in different schools with attendant implications for differential treatment. Apart
from an overall and general assessment of performance, analysis was made of
demographic variables, for example, sex, intelligence, age and social development. It is
concluded that specific teaching approaches can significantly effect the development of
children with Down's syndrome in such creative aspects of the curriculum as music,
movement and dance.
 Ulrich DA et al., (2007) examined the effects of intensity of treadmill training on
developmental outcomes and stepping in infants with Down syndrome: a randomized
trial. BACKGROUND AND PURPOSE: Infants with Down syndrome (DS) are
consistently late walkers. The purpose of this investigation was to test the effects of
individualized, progressively more intense treadmill training on developmental
outcomes in infants with DS. SUBJECTS: Thirty infants born with DS were randomly
assigned to receive lower-intensity, generalized treadmill training or higher-intensity,
and individualized training implemented by their parents in their homes. METHODS:
Research staff members monitored implementation of training, physical growth, and
onset of motor milestones of all infants on a monthly basis. RESULTS: Infants in the
higher-intensity, individualized training group increased their stepping more
dramatically over the course of training. Infants in the higher-intensity training group
attained most of the motor milestones at an earlier mean age. DISCUSSION AND
CONCLUSION: Treadmill training of infants with DS is an excellent supplement to
regularly scheduled physical therapy intervention for the purpose of reducing the delay
in the onset of walking.

Taggert, H. M et al., (2003) undertook a study to evaluate the effects of tai chi
exercise on fibromyalgia symptoms and health related quality of life. Fibromyalgia (FM)
is among the most widespread of musculoskeletal disorders, affecting 6 million
Americans. The condition represents a conundrum for the researcher as well as for the
health care worker. Its biophysical characteristics are poorly understood along with the
many associated problems, such as impaired global health, high disability level,
decreased functional levels, and inadequate symptom relief. Strategies for treatment
should be dynamic and include not only pharmacological, but also physical,
psychological, and educational approaches. According to the researchers, the most
positive treatments are those that include both mind-body therapy and exercise. Tai Chi
is often called meditation in motion and combines mind-body therapy and physical
exercise. The researchers hypothesized that there would be positive changes in pre-
exercise to post-exercise scores for FM symptoms, and positive changes in pre-exercise
to post-exercise scores for health status after six weeks of twice-weekly, 1-hour classes
in Yang-style Tai Chi.

Maria Fragala-Pinkham et.al., (2008) studied the Group aquatic aerobic exercise
for children with disabilities. The effectiveness and safety of a group aquatic aerobic
exercise program on cardiorespiratory endurance for children with disabilities was
examined using an A–B study design. Sixteen children (11 males, five females) age
range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice-per-week
program lasting 14 weeks. The children's diagnoses included autism spectrum disorder,
myelomeningocele, cerebral palsy, or other developmental disability. More than half of
the children ambulated independently without aids. Children swam laps and participated
in relay races and games with a focus of maintaining a defined target heart rate zone.
The strengthening component consisted of exercises using bar bells, aquatic noodles,
and water resistance. The following outcomes were measured: half-mile walk/run,
isometric muscle strength, timed floor to stand 3-meter test, and motor skills.
Complaints of pain or injury were systematically collected. Significant improvements in
the half-mile walk/run were observed, but not for secondary outcomes of strength or
motor skills. The mean program attendance was 80%, and no injury was reported.
Children with disabilities may improve their cardiorespiratory endurance after a group
aquatic aerobic exercise program with a high adult:child ratio and specific goals to
maintain training heart rates.

Cheryl Missiuna et.al., (2008) conducted a study on the Description of children

identified by physicians as having developmental coordination disorder. The aim of this
study was to describe in detail a large group of children aged 4 to 12 years who were
diagnosed with developmental coordination disorder (DCD) by physicians following a
rigorous multidisciplinary procedure. As part of a community-based DCD knowledge
translation program, physicians received specialized training and were invited to identify
children with probable DCD who were referred for further investigation to help confirm
the diagnosis. Of 116 children (87 males, 29 females; age range 4y 1mo - 12y 11mo,
mean age 8y) identified as having probable DCD by physician participants, 88 (76%)
were subsequently diagnosed with DCD and 77.3% of these demonstrated a high degree
of motor impairment. All children who were diagnosed experienced difficulties in self-
care and/or academic or leisure activities. The male:female ratio was 3:1 and the
incidence of preterm births among this sample was 12.5%. We conclude that, given the
expense involved with ruling out differential diagnoses, it can be difficult to adhere
rigorously to diagnostic criteria for DCD in clinical practice and research. This
description of a group of children actually diagnosed with DCD helps to clarify the
characteristics of these children as well as issues related to the refinement of diagnostic
criteria.
Wind WM et al., (2004) conducted a study on Sports for the physically
challenged child and his findings indicated that participation in sports is important for the
physical and emotional health of the physically challenged child. Sports can improve
strength, endurance, and cardiopulmonary fitness while providing companionship, a
sense of achievement, and heightened self-esteem. With interest in such participation
increasing, it is necessary for the physicians, therapists, and families of children with
special needs to understand the pre participation evaluation, athletic options, specialized
equipment, and sport-specific risks. Recommendations that provide guidelines for safe,
effective participation in sports are currently available for common congenital and
developmental disabilities such as Down syndrome, cerebral palsy, myelodysplasia,
hemophilia, congenital amputations, and arthritic disorders.

Vos-Vromans DC et.al., (2005) investigated the Responsiveness of evaluative

measures for children with cerebral palsy: the Gross Motor Function Measure and the
Pediatric Evaluation of Disability Inventory,this study is to describe responsiveness of the
Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability
Inventory (PEDI) in a group of children with cerebral palsy (CP). METHOD: The
subjects were 55 children with cerebral palsy aged 2 to 7 years (mean 4.6 years). We
described the responsiveness of the GMFM and PEDI for all children (n = 55), for
children than 4 years of age (n = 22) and those older or equal to 4 years (n = 33). Two
frames of references for determining responsiveness were used: change over time and
external criterion. Responsiveness was calculated with help of the Effect Size (ES),
Standardised Response Mean (SRM) and Spearman rank order correlations of change on
both the PEDI and GMFM, with change in motor functioning according to the parents as
external criterion. RESULTS: The PEDI has ES and SRM values higher than 0.8. The
GMFM has ES and SRM values higher than 0.5. For all dimensions of the PEDI and for
almost all dimensions of the GMFM, the ESs and SRMs of the younger group are higher
than those of the older group. The ES and the SRM of the GMFM increase with the
complexity of the task. When looking at the correlations of the PEDI and GMFM change
scores with the opinion of parents, the results are less unequivocal. CONCLUSIONS:
Both the GMFM and the PEDI are responsive for change in motor ability over time in
children with CP, the most in children younger than 4 years of age.
Parker DF, et.al.,(1993) studied Muscle performance and gross motor function
of children with spastic cerebral palsy this study was to determine whether, and to what
extent, performance on a measure of motor function (Gross Motor Function Measure,
GMFM) was related to the physiological fitness of children with cerebral palsy (CP).
Two elements of physiological function were measured: aerobic power and anaerobic
power of the arms and legs. 15 boys and eight girls aged between seven and 13.9 years
with spastic CP participated in the study. There was a good relationship between the
standing and walking, running and jumping sub-sections and the total score of the
GMFM on one hand, and anaerobic capacity of the legs on the other. However, the
relationships for the arms were limited, indicating that the GMFM is not a suitable tool
for providing information about aerobic fitness in children with CP, or about anaerobic
power of the arms.
Rintala P and Linjala J., (2003) investigated to Scores on test of gross motor
development of children with dysphasia: a pilot study. The purpose of this preliminary
investigation was to assess the gross motor skill and trainability of children with
dysphasia using the Test of Gross Motor Development. 27 children from 7 to 12 years
(M=9.6 yr., SD=1.3) from four different classes in one special school participated. The
gross motor skill scores of a sample of children with dysphasia, their trainability of the
gross motor skills, and the intrarater reliability of the test were examined. Based on the
videotaped performances the intrarater reliability was .93 to .97 for total scores, but lower
for individual test items. Mean motor skill scores of these children with dysphasia were
interpreted as 'poor' relative to those of the standardization and the reference group. The
8-wk. intervention showed statistically significant improvement from pre- to posttest
values. Mean locomotor skills improved from 2.7 (SD=.4) to 2.8 (SD=.4), and the object
control skills from 2.4 (SD=.7) to 2.8 (SD=.7). It appears these children with language
disorders do not possess a similar basic gross motor level as their peers without language
problems.
Cermak and Sharon., (2006) conducted a study on Physical Activity,
Fitness and Obesity in Children with Coordination Disorders, The long-term goals of this
project are to identify factors that contribute to inadequate physical activity in children
with Developmental Coordination Disorder (DCD) and to develop interventions to
promote physical activity and reduce health risk. Lack of adequate physical activity is a
significant health problem in children in the United States. While considerable efforts are
underway to understand and address the problem of low physical activity levels in the
general population, there has been little research in children with disabilities. We propose
that children with DCD are at particular risk for low activity, low levels of fitness and
obesity due to the nature of their disorder. DCD is a neurologically-based developmental
disorder characterized by impaired motor coordination that significantly interferes with
academic achievement and activities of daily living. Because of poor coordination,
children with DCD often are unable to participate in sports and physical activities with
their peers. The goals of this study are to test our overarching hypothesis that children
with DCD are less active, more sedentary, and thus are at greater risk for obesity and
lower levels of fitness than children with adequate motor coordination. We will examine
if the association of participation in physical activity and time spent in sedentary behavior
with fitness and with weight status differs between children with DCD and with adequate
motor coordination. We will use state-of-the-art methodology to measure activity level
(accelerometry). We will determine whether children with DCD show significantly lower
overall activity, spend less time in moderate-vigorous activity and more time in sedentary
behavior, have significantly lower levels of physical fitness and significantly higher BMI
z-scores and prevalence of risk for obesity (>85th percent), than children with average
motor coordination. The relationship among measures will be examined to understand
whether physical activity in children with DCD has the same effect on weight status and
fitness as in children with adequate coordination. This project is responsive to Healthy
People 2010 objectives which seek to increase physical activity among the nation's youth.
Children with DCD represent a substantial number of children in the population who, due
to their coordination disorders, are at even higher risk. The study has broader
implications to other children with special needs such as those with learning disabilities
and autism who also have been identified as having coordination deficits that may limit
participation.
Dykens EM et.al., (1998) conducted a study on Exercise and sports in children
and adolescents with developmental disabilities. Positive physical and psychosocial
effects. This article reviews findings to date on the effects of exercise and sports in
children and adolescents with developmental disabilities. Although much work remains,
exercise and sports are associated with reduced maladaptive behavior in children with
disabilities, as well as with improved physical fitness, self-esteem, and social
competence. Improved physical and psychosocial functioning are found in studies of both
children and adults with mental retardation, as well as in research on athletes enrolled in
Special Olympics International, the largest recreational sport program in the world for
persons with developmental disabilities. The review ends with recommendations for
promoting recreation and sports in children and adolescents with disabilities.
Tofler IR et al.,(2005) investigated the Developmental overview of child and
youth sports for the twenty-first century. This article presents an overview of sporting
participation for children and adolescents from psychological, physical, social,
developmental, and historical perspectives. The following areas are reviewed: (1) normal
developmental readiness and sporting participation; (2) benefits and risks of athletic
participation for the child and adolescent; (3) self concept and sporting participation; (4)
adverse psycho physiological and somatoform effects of sports; (5) interactional and
systemic contributions to adverse physical and psychological effects; (6) a
historical/social perspective of sport in the United States; (7) the current and future role
of psychiatrists in conjunction with sports medicine physicians; (8) the sports psychiatry
interview of the child, family, and coach; and (9) summary and future challenges.
Patel DR et al., (2002) conducted a study on Paediatric neurodevelopment and
sports participation. When are children ready to play sports? A fundamental knowledge
of normal child and adolescent development is essential to providing a developmentally
appropriate sports experience for the child, and to providing guidance to parents
regarding their child's sport participation. This article reviews neurodevelopment, normal
child and adolescent development relevant to sport participation, and developmental
readiness to participate in sports. Neurodevelopment maturation is a complex, continuous
process. The sense of social comparison is not achieved until after 6 years of age, and the
ability to understand the competitive nature of sports is generally not achieved until 9
years of age. By about 12 years of age, most children are mature enough to comprehend
the complex tasks of sports and are physically and cognitively ready to participate in
competitive sports with appropriate supervision.
Robert W et al., (2007) undertook a study to evaluate the effect of a bout of
unloaded leg cycling on the soleus H-reflex and modified Ashworth scale (MAS) in 6
individuals with multiple sclerosis (MS) who had spasticity of the leg muscles and were
currently taking anti-spastic medications. H-reflex and MAS data were collected before
and 10, 30, and 60 min after 20 min of unloaded leg cycling and a control condition. The
unloaded leg cycling resulted in concomitant reductions in soleus H-reflex and MAS
scores compared with the control condition. This provides a basis for incorporating
exercise along with anti-spastic medications into a multifaceted plan for spasticity
management in individuals with MS.

Volman MJ et al., (2007) intervened the Functional status in 5 to 7-year-old

children with Down syndrome in relation to motor ability and performance mental
ability. The purpose to examine the contribution of motor ability and 'performance'
mental ability on functional skills in children with Down syndrome (DS). METHOD: A
structural equation modelling approach was used to test the relation between motor
ability, performance mental ability and functional status. Functional status was assessed
with the Pediatric Evaluation Disability Inventory (PEDI), motor ability with the
Movement Assessment Battery for Children (M-ABC), and performance mental ability
was assessed with the Gross-Form Board (GFB). Sixty-five children with DS, selected
by the Dutch Down Syndrome Foundation, were asked to participate in the study. Data
were analysed with the programme AMOS using the Bollen-Stine bootstrap method.
Chi2 and NFI index were used as goodness-of-fit indices. RESULTS: The fit of the
model was good (chi2 4 = 1.35, p = 0.85; and NFI = 0.99). 'Functional status' explained
70% of the variance in the model. Standardized regression weights indicated that motor
ability was a far better predictor of functional status of children with DS than
performance mental ability (0.96 vs. 0.17). CONCLUSIONS: Limitations in functional
activities of 5 to 7-year-old children with Down syndrome seem to be more related to
the level of motor ability than to the level of performance mental ability.

Connolly BH, and Michael BT, (1986) studied the Performance of retarded
children, with and without Down syndrome, on the Bruininks Oseretsky Test of Motor
Proficiency. The purpose of this study was to examine the gross motor and fine motor
abilities of children with mental retardation using the Bruininks Oseretsky Test of
Motor Proficiency. We compared the motor skills of 24 mentally retarded children, 12
with Down syndrome and 12 without Down syndrome. The children ranged in
chronological age from 7.6 years to 11 years and were of comparable mental age.
Within each group, there were no significant sex differences nor were there differences
between the two groups in motor performance for the male subjects. The female
subjects with Down syndrome, however, scored significantly lower than female subjects
without Down syndrome on running speed, strength, visual motor ability, speed, and
dexterity and fine motor composite scores. As a group, the children with Down
syndrome scored significantly lower than the children without Down syndrome in the
areas of running speed, balance, strength, and visual motor control. The gross motor and
fine motor skill composite scores were also significantly lower for the children with
Down syndrome than for the children without Down syndrome.

Henderson SE et al, (1981) conducted a study on the Performance of Down

syndrome and other retarded children on the Cratty Gross-Motor Test. The Cratty Test
of Gross-Motor Performance was administered to 18 Down syndrome and 18 other
mentally retarded children between the ages of 7 and 14 years. Subjects were
individually matched on both MA and CA. Examination of their test profiles showed
that the Down syndrome children had consistently lower scores that did the matched
control children, but only two of the differences were significant. The findings,
therefore, provide tentative support for the notion that Down syndrome children suffer a
specific deficit in some areas of motor coordination. A number of criticisms of the
internal consistency of the test were discussed in terms of their theoretical and practical
implications.

Kerr R, and Blais C, (1985) Studied the Motor skill acquisition by individuals
with Down syndrome. Motor skill acquisition of subjects with Down syndrome on a
pursuit tracking task was assessed in comparison to groups of mentally retarded subjects
without Down syndrome and nonretarded subjects matched for functional age and
chronological age (CA). Thirty-seven male subjects performed eight trials on a subject-
paced pursuit tracking task. The main finding was that subjects with Down syndrome
did not respond to directional probability in the same manner shown by the retarded or
the nonretarded subjects matched for CA or functional age. This difference in strategy
was also reflected in their greater emphasis on accuracy rather than speed. Finally, these
effects were consistent across the subjects with Down syndrome despite the large inter
subject variability seen in their performance.

Kerr R, and Blais C, (1987) conducted a study on Down syndrome and extended
practice of a complex motor task. Mentally retarded subjects with and without Down
syndrome made 2,400 responses on a discrete pursuit-tracking task. Both groups
showed significant improvement on the task such that their performance was
comparable to nonretarded subjects at the same functional level. Although the
previously noted failure (Blais & Kerr, 1986; Kerr & Blais, 1985) of the subjects with
Down syndrome to spontaneously use the directional probability information available
in the task was moderated, differences remained that may reflect processing limitations.

Kioumourtzoglou E et al, (1994) analysed selected motor skills of mentally

retarded and non retarded individuals. The aim of this study was to examine whether
mentally retarded individuals show a specific motor performance deficit on measures of
reaction time, aiming, and dexterity. 23 mentally retarded adolescents and two control
groups of 22 non-retarded persons of the same mental age and 20 nonretarded persons
of the same chronological age were tested. Motor performance measures for retarded
persons were considerably longer than those of nonretarded persons of the same
chronological age and of the same mental age. Only time of finger dexterity with short
pins was longer for the retarded than for the nonretarded adolescents of the same mental
age. Reaction times across groups were faster for the sound than for the light signal. No
difference in RT for fine movement was observed. Differences among the various motor
performance measures for retarded and nonretarded subjects are confirmed.

Yoon DY et al, (2006) reviewed three tests of motor proficiency in children. The
present purpose is to provide clinicians, occupational and physical therapists, and
educators with a comparative analysis of three tests of motor proficiency. The
Bruininks-Oseretsky Test of Motor Proficiency, Movement Assessment Battery for
Children, and Tufts Assessment of Motor Performance were developed to assess the
motor skills of children with developmental delays. The selection criteria, inter rate
reliability, reproducibility, and recommended use of each test are reported here.
Recommendations for use of each test include standardization of the sample population
to ensure its appropriateness.

Kessler J et al, (1988) studied the Cognitive functioning of juveniles with Down
syndrome and other forms of mental retardation. The performance of juvenile Down
syndrome individuals and two groups of oligophrenes was compared in several
cognitive tests. All three groups of subjects were of the same CA, the Down's and one
group of mentally retarded non-Down's had an average MA of 62, the other group an
MA of 86 months. Though the group with the highest mental age usually outperformed
the other two, significant differences were rare. It is concluded that at this age Down's
and mentally retarded with different etiologies generally have rather similar cognitive
abilities and that the intellectual deterioration of Down's, which at a later age inevitably
leads to Alzheimer's disease, indeed starts only at a later CA.

Stratford B and Ching EY., (1989) intervened the Responses to music and
movement in the development of children with Down's syndrome. Physical responses to
rhythmic stimuli and music, of different degrees of complexity were registered from 25
children with Down's syndrome and 25 other mentally handicapped children. Required
performances were taught and then recorded on video-tape, after which they were
assessed by experienced teacher/judges. Whilst there were no overall significant
differences between the groups, important differences were detected between the
children in different schools with attendant implications for differential treatment. Apart
from an overall and general assessment of performance, analysis was made of
demographic variables, for example, sex, intelligence, age and social development. It is
concluded that specific teaching approaches can significantly effect the development of
children with Down's syndrome in such creative aspects of the curriculum as music,
movement and dance.

Clements W and Barrett M., (1994) studied the drawings of children and young
people with Down's syndrome: a case of delay or difference? This study compared the
performance of 29 children and young people with Down's syndrome with the
performance of 29 verbal-mental-age-matched children without learning difficulties on
four drawing tasks and four picture-selection tasks. All eight tasks involved the graphic
depiction of a perceptually-present array in which one object was partially occluded by
another object. It was found that all participants performed better on the picture-
selection tasks than on the drawing tasks, and that the individuals with Down's
syndrome performed significantly worse than the children without learning difficulties
on all eight tasks. However, it was also found that the performance of the children
without learning difficulties correlated strongly with their verbal mental age, but that the
performance of the individuals with Down's syndrome did not show the same
correlation with verbal mental age. Other systematic differences between the drawings
of the individuals with Down's syndrome and those of the children without learning
difficulties also occurred. The findings suggest that the drawing development of
children and young people with Down's Syndrome may not just be delayed relative to
that of children who do not have learning difficulties but may exhibit a qualitatively
different pattern.

Wishart JG., (1993) experienced the development of learning difficulties in

children with Down's syndrome. This paper examines individual developmental profiles
drawn from a series of longitudinal studies of cognitive development and problem-
solving in children with Down's syndrome (DS) from birth to 11 years of age. These
highlight the difficulties in explaining DS development in terms of a slowed-down
version of normal development and illustrate how, from a very early age, developmental
progress in DS is undermined by the children's failure to exercise and maintain existing
skills and by their counter-productive approach to learning new skills. Developmental
instability and inefficient learning were found to characterize performance on
contingency detection tasks, on tests of object concept development, and on
standardized intelligence tests. Implications of the findings for assessment, educational
practice and developmental theory are discussed.

Stratford B., (1979) intervened the Attraction to "good form" in Down's

syndrome. Seventy-five children were examined in tasks involving matching figures in
order to establish whether there exists a specific attraction to symmetrical or Gestalt
type "good form" displays in mentally handicapped children and particularly in Down's
Syndrome or if the tendency was towards image reversal. Twenty-five children with
Down's syndrome were matched on M.A. with twenty-five non-Down's Syndrome sub
normal and twenty-five normal children. Symmetrical and asymmetrical displays were
presented to the groups for reproduction and reproduction from memory. The results
supported the hypothesis that mentally handicapped children have a significant
attraction to symmetrical arrangements and that Down's syndrome children are more
significantly attracted than other handicapped children. Evidence is presented to show
that what often is mistaken for a tendency to image reversal is in fact an attraction to
"mono tonicity" and is more related to "good form" than to reversal.

Ketelaar M et al, (1998) intervened the Functional motor abilities of children

with cerebral palsy: a systematic literature review of assessment measures. To provide
an overview of functional assessment measures for children with cerebral palsy,
supporting the selection of measures and the interpretation of results from measures.
METHODS: Instruments were selected on the basis of a literature search of the
Medline, Sportdisk and PsychLIT databases. ISSUES REVIEWED: Instruments were
reviewed with respect to target group, purpose, nature, type and psychometric
properties. RESULTS: In the literature 17 instruments that are used in paediatric
rehabilitation and paediatric physical therapy to assess the functional motor abilities of
children with cerebral palsy were found. While there is an urgent need for measures that
can evaluate change in functional abilities, it was found that most measures are
developed and validated for discriminative purposes. CONCLUSIONS: Although
instruments developed within the last decade meet psychometric criteria more
adequately than those developed previously, it is concluded that only two evaluative
assessment measures, the Gross Motor Function Measure (GMFM) and the Pediatric
Evaluation of Disability Inventory (PEDI), fulfil the criteria of reliability and validity
with respect to responsiveness to change.

Ketelaar M et al, (2001) studied the Effects of a functional therapy program on

motor abilities of children with cerebral palsy. The purpose of this study was to
determine whether the motor abilities of children with spastic cerebral palsy who were
receiving functional physical therapy (physical therapy with an emphasis on practicing
functional activities) improved more than the motor abilities of children in a reference
group whose physical therapy was based on the principle of normalization of the quality
of movement. The subjects were 55 children with mild or moderate cerebral palsy aged
2 to 7 years (median=55 months). A randomized block design was used to assign the
children to the 2 groups. After a pretest, the physical therapists for the functional
physical therapy group received training in the systematic application of functional
physical therapy. There were 3 follow-up assessments: 6, 12, and 18 months after the
pretest. Both basic gross motor abilities and motor abilities in daily situations were
studied, using the Gross Motor Function Measure (GMFM) and the self-care and
mobility domains of the Pediatric Evaluation of Disability Inventory (PEDI),
respectively. RESULTS: Both groups had improved GMFM and PEDI scores after
treatment. No time x group interactions were found on the GMFM. For the PEDI, time x
group interactions was found for the functional skills and caregiver assistance scales in
both the self-care and mobility domains. The groups' improvements in basic gross motor
abilities, as measured by the GMFM in a standardized environment, did not differ.
When examining functional skills in daily situations, as measured by the PEDI, children
in the functional physical therapy group improved more than children in the reference
group.

Engelen V et al, (2007) conducted a study on selecting the appropriate outcome in

paediatric physical therapy: how individual treatment goals of children with cerebral
palsy are reflected in GMFM-88 and PEDI. To assess to what extent individual physical
therapy treatment goals for children with cerebral palsy are reflected in 2 standardized
measures: the GMFM-88 and the PEDI. SUBJECTS: A total of 36 paediatric physical
therapists working in primary healthcare with children with cerebral palsy in their
caseload. The International Classification of Functioning, Disability and Health was
used as a measure to link individual treatment goals to the GMFM-88 and the PEDI.
Sixty percent of the treatment goals were covered by the 2 measures. Twenty-seven
percent and 21% of the goals were reflected in the GMFM-88 and the PEDI,
respectively; 12% of the goals were reflected in both instruments. Another 26% of the
treatment goals appeared to be partly covered (21% in PEDI and 5% in GMFM-88).
Fourteen percent of the goals were not covered by the 2 measures. Individual goals set
in a physical therapy practice for children with cerebral palsy can be linked, to a large
extent, to items and activities of 2 standardized measures.

Vos-Vromans DC et al, (2005) conducted a study on Responsiveness of

evaluative measures for children with cerebral palsy: the Gross Motor Function
Measure and the Pediatric Evaluation of Disability Inventory. The aim of this study is to
describe responsiveness of the Gross Motor Function Measure (GMFM) and the
Pediatric Evaluation of Disability Inventory (PEDI) in a group of children with cerebral
palsy (CP). The subjects were 55 children with cerebral palsy aged 2 to 7 years (mean
4.6 years). We described the responsiveness of the GMFM and PEDI for all children (n
= 55), for children younger than 4 years of age (n = 22) and those older or equal to 4
years (n = 33). Two frames of references for determining responsiveness were used:
change over time and external criterion. Responsiveness was calculated with help of the
Effect Size (ES), Standardised Response Mean (SRM) and Spearman rank order
correlations of change on both the PEDI and GMFM, with change in motor functioning
according to the parents as external criterion. The PEDI has ES and SRM values higher
than 0.8. The GMFM has ES and SRM values higher than 0.5. For all dimensions of the
PEDI and for almost all dimensions of the GMFM, the ESs and SRMs of the younger
group are higher than those of the older group. The ES and the SRM of the GMFM
increase with the complexity of the task. When looking at the correlations of the PEDI
and GMFM change scores with the opinion of parents, the results are less unequivocal.
Both the GMFM and the PEDI are responsive for change in motor ability over time in
children with CP, the most in children younger than 4 years of age.

Harvey A et al, (2008) viewed as a systematic review of measures of activity

limitation for children with cerebral palsy. This systematic review critically appraises
the literature on the psychometric properties and clinical utility of evaluative activity
limitation outcome measures used for children with cerebral palsy (CP). The search
strategy yielded 29 articles for eight outcome measures that met the inclusion criteria
for the review. The Gross Motor Function Measure and Activities Scale for Kids were
found to have sound psychometric properties in most areas. Reliability was found to be
adequate for all tools. For the CP population, further examination of some aspects of
validity is required for the Child Health Questionnaire (CHQ), Functional Assessment
Questionnaire (FAQ), Functional Mobility Scale (FMS), Pediatric Evaluation of
Disability Inventory, Pediatric Outcomes Data Collection Instrument (PODCI), and the
Functional Independence Measure for Children. The FAQ, CHQ, FMS, and PODCI
were found to require further examination for responsiveness. Clinical utility of the
measures varied. The FMS was the only one to differentiate between function in the
home, school, and community and to consider different assistive devices. These findings
suggest that a range of measures is required to evaluate activity, and assessment should
be tailored to the individual needs of children with CP.

Stiller C et al, (2003) intervened the effect of conductive education, intensive

therapy, and special education services on motor skills in children with cerebral palsy.
The purpose of this study was to compare the effects of intensive therapy, conductive
education, and special education on function in 19 children with cerebral palsy. Subjects
participated in a five-week program of conductive education, intensive therapy, or
special education. Professionals, blinded to group assignment, administered the
Pediatric Evaluation of Disability Inventory (PEDI), the Gross Motor Function Measure
(GMFM), and the Fine Motor Scale of the Peabody Developmental Motor Scales before
and after intervention. Professionals providing treatment and parents completed a
survey about their perceptions of change in the children. ANOVA showed no
statistically significant differences between groups before or after treatment. Using t-
tests, statistically significant within group changes were found only for the intensive
therapy group on the PEDI Self-care and Social Function scales and the Crawling and
Kneeling scale of the GMFM. Individual changes from pre- to post-test were also
examined and are discussed. Surveys revealed that both parents and professionals
perceived improvement in all children. Greatest improvements were noted in the group
receiving intensive therapy, with children in all groups showing some improvement in
function.

Odman P, and Oberg B., (2005) studied the Effectiveness of intensive training
for children with cerebral palsy--a comparison between child and youth rehabilitation
and conductive education. To compare the short-term effectiveness of 1 intensive
training period in child and youth rehabilitation with Move&Walk conductive education
and describe the effects of 1 intensive training period in terms of changes at 1 year. The
amount and influence of additional consumption of training during the 1-year follow-up
was also analysed. Quasi-experimental with 2 groups: Lemo (n=23) and Move&Walk
(n=29). PATIENTS: A total of 52 children with cerebral palsy, age range 3-16 years.
Data included repeated measures with Gross Motor Function Measure (GMFM) and
Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Data on
additional consumption of training was collected at the 1-year follow-up. There was no
difference in proportion of change on the clinical measures between the training
programmes, except for a higher proportion of improvement on the GMFM total score
in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS
in the short-term and on PEDI FS only at 1 year. A higher proportion of children who
participated in repeated intensive training periods showed improved social functioning.
CONCLUSION: No major differences were shown between the 2 training programmes.
One intensive training period facilitated small improvements in gross motor function.
The majority of children had a high consumption of training during the 1-year follow-up
and the added value of repeated intensive training periods was limited.

Casady RL, and Nichols-Larsen DS., (2004) studied the effect of hippo therapy
on ten children with cerebral palsy. The purpose of this study was to determine whether
hippotherapy has an effect on the general functional development of children with
cerebral palsy. The study employed a repeated-measures design with two pre-tests and
two post-tests conducted 10 weeks apart using the Pediatric Evaluation of Disability
Inventory (PEDI) and the Gross Motor Function Measure (GMFM) as outcome
measures. A convenience sample of 10 children with cerebral palsy participated whose
ages were 2.3 to 6.8 years at baseline (mean +/- SD 4.1 +/- 1.7). Subjects received
hippotherapy once weekly for 10 weeks between pre-test 2 and post-test 1. Test scores
on the GMFM and PEDI were compared before and after hippotherapy. One-way
analysis of variance of group mean scores with repeated measures was significant (p <
0.05) for all PEDI subscales and all GMFM dimensions except lying/rolling. Post hoc
analyses with the Tukey test for honest significant differences on the PEDI and GMFM
total measures as well as GMFM crawling/kneeling and PEDI social skills subtests were
statistically significant between pre-test 2 and post-test 1. CONCLUSIONS: The results
of this study suggest that hippotherapy has a positive effect on the functional motor
performance of children with cerebral palsy. Hippotherapy appears to be a viable
treatment strategy for therapists with experience and training in this form of treatment
and a means of improving functional outcomes in children with cerebral palsy, although
specific functional skills were not investigated.

McGibbon NH et al, (1998) intervened the Effect of an equine-movement therapy

program on gait, energy expenditure, and motor function in children with spastic
cerebral palsy: a pilot study. The purpose of this study was to evaluate the effects of an
8-week program of hippotherapy on energy expenditure during walking; on the gait
dimensions of stride length, velocity, and cadence; and on performance on the Gross
Motor Function Measure (GMFM) in five children with spastic cerebral palsy (CP). A
repeated-measures within-subjects design was used consisting of two baseline
measurements taken 8 weeks apart, followed by an 8-week intervention period, then a
post test. After hippotherapy, all five children showed a significant decrease (X2(r)=7.6,
P<0.05) in energy expenditure during walking and a significant increase (X2(r)=7.6,
P<0.05) in scores on Dimension E (Walking, Running, and Jumping) of the GMFM. A
trend toward increased stride length and decreased cadence was observed. This study
suggests that hippotherapy may improve energy expenditure during walking and gross
motor function in children with CP.

Knox V, and Evans AL (2002) conducted a study on Evaluation of the functional

effects of a course of Bobath therapy in children with cerebral palsy: a preliminary
study. This study aimed to evaluate functional effects of Bobath therapy in children with
cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6
females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years).
Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia
(n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed
across the following Gross Motor Function Classification levels: level I, n=1; level II,
n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic
intervention were excluded. A repeated measures design was used with participants
tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of
Disability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath
therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were
used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in
the following areas following Bobath therapy compared with the periods before and
after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI
self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This
demonstrates that in this population, gains were made in motor function and self care
following a course of Bobath therapy.

Blundell SW et al, (2003) intervened the Functional strength training in cerebral

palsy: a pilot study of a group circuit training class for children aged 4-8 years. To
determine the effects of intensive task-specific strength training on lower limb strength
and functional performance in children with cerebral palsy. DESIGN: A nonrandomized
ABA trial. SETTING: Sydney school. SUBJECTS: Eight children with cerebral palsy,
aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic
quadriplegia. Four weeks of after-school exercise class, conducted for one hour twice
weekly as group circuit training. Each work station was set up for intensive repetitive
practice of an exercise. Children moved between stations, practising functionally based
exercises including treadmill walking, step-ups, sit-to-stands and leg presses. Baseline
test obtained two weeks before training, a pre-test immediately before and a post-test
following training, with follow-up eight weeks later. Lower limb muscle strength was
tested by dynamometry and Lateral Step-up Test; functional performance by Motor
Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-
minute walk test. RESULTS: Isometric strength improved pre- to post-training by a
mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD
15). Children walked faster over 10 m, with longer strides, improvements of 22% and
38% respectively. Sit-to-stand performance had improved, with a reduction of seat
height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training
all improvements had been maintained. CONCLUSIONS: A short programme of task-
specific strengthening exercise and training for children with cerebral palsy, run as a
group circuit class, resulted in improved strength and functional performance that was
maintained over time.

Odman P, and Oberg B. (2005) compared the Effectiveness of intensive training

for children with cerebral palsy--a comparison between child and youth rehabilitation
and conductive education. To compare the short-term effectiveness of 1 intensive
training period in child and youth rehabilitation with Move&Walk conductive education
and describe the effects of 1 intensive training period in terms of changes at 1 year. The
amount and influence of additional consumption of training during the 1-year follow-up
was also analysed. DESIGN: Quasi-experimental with 2 groups: Lemo (n=23) and
Move&Walk (n=29). A total of 52 children with cerebral palsy, age range 3-16 years.
Data included repeated measures with Gross Motor Function Measure (GMFM) and
Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Data on
additional consumption of training was collected at the 1-year follow-up. RESULTS:
There was no difference in proportion of change on the clinical measures between the
training programmes, except for a higher proportion of improvement on the GMFM
total score in Lemo. At the group level, small improvements were shown on GMFM and
PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of
children who participated in repeated intensive training periods showed improved social
functioning. CONCLUSION: No major differences were shown between the 2 training
programmes. One intensive training period facilitated small improvements in gross
motor function. The majority of children had a high consumption of training during the
1-year follow-up and the added value of repeated intensive training periods was limited.
 Parker DF et al, (1993) studied the Muscle performance and gross motor function
of children with spastic cerebral palsy. The purpose of this study was to determine
whether, and to what extent, performance on a measure of motor function (Gross Motor
Function Measure, GMFM) was related to the physiological fitness of children with
cerebral palsy (CP). Two elements of physiological function were measured: aerobic
power and anaerobic power of the arms and legs. 15 boys and eight girls aged between
seven and 13.9 years with spastic CP participated in the study. There was a good
relationship between the standing and walking, running and jumping sub-sections and
the total score of the GMFM on one hand, and anaerobic capacity of the legs on the
other. However, the relationships for the arms were limited, indicating that the GMFM
is not a suitable tool for providing information about aerobic fitness in children with CP,
or about anaerobic power of the arms.

Rintala P, and Linjala J. (2003) studied the Scores on test of gross motor
development of children with dysphasia: a pilot study. The purpose of this preliminary
investigation was to assess the gross motor skill and trainability of children with
dysphasia using the Test of Gross Motor Development. 27 children from 7 to 12 years
(M=9.6 yr., SD=1.3) from four different classes in one special school participated. The
gross motor skill scores of a sample of children with dysphasia, their trainability of the
gross motor skills, and the intrarater reliability of the test were examined. Based on the
videotaped performances the intrarater reliability was .93 to .97 for total scores, but
lower for individual test items. Mean motor skill scores of these children with dysphasia
were interpreted as 'poor' relative to those of the standardization and the reference
group. The 8-wk. intervention showed statistically significant improvement from pre- to
posttest values. Mean locomotor skills improved from 2.7 (SD=.4) to 2.8 (SD=.4), and
the object control skills from 2.4 (SD=.7) to 2.8 (SD=.7). It appears these children with
language disorders do not possess a similar basic gross motor level as their peers
without language problems.
 Robert W. Motl et al, (2007) studied the effect of acute unloaded leg cycling on
spasticity in individuals with multiple sclerosis using anti-spastic medications. This
article examined the effect of a bout of unloaded leg cycling on the soleus H-reflex and
modified Ashworth scale (MAS) in 6 individuals with multiple sclerosis (MS) who had
spasticity of the leg muscles and were currently taking anti-spastic medications. H-
reflex and MAS data were collected before and 10, 30, and 60 min after 20 min of
unloaded leg cycling and a control condition. The unloaded leg cycling resulted in
concomitant reductions in soleus H-reflex and MAS scores compared with the control
condition. This provides a basis for incorporating exercise along with anti-spastic
medications into a multifaceted plan for spasticity management in individuals with MS.

Lotta Ahlborg et al (2006) intervened the whole-body vibration training

compared with resistance training: effect on spasticity, muscle strength and motor
performance in adults with cerebral palsy. The aim of this study was to evaluate the
effect on spasticity, muscle strength and motor performance after 8 weeks of whole-
body vibration training compared with resistance training in adults with cerebral palsy.
Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention
with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and
post-training measures of spasticity using the modified Ashworth scale, muscle strength
using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance
using Timed Up and Go test and gross motor performance using Gross Motor Function
Measure were performed. Spasticity decreased in knee extensors in the whole-body
vibration group. Muscle strength increased in the resistance training group at the
velocity 30°/s and in both groups at 90°/s. Six-Minute Walk Test and Timed Up and Go
test did not change significantly. Gross Motor Function Measure increased in the whole-
body vibration group. Conclusion: These data suggest that an 8-week intervention of
whole-body vibration training or resistance training can increase muscle strength,
without negative effect on spasticity, in adults with cerebral palsy.
 Cermak, and Sharon (2006) studied the Physical Activity, Fitness and Obesity in
Children with Coordination Disorders. The long-term goals of this project are to
identify factors that contribute to inadequate physical activity in children with
Developmental Coordination Disorder (DCD) and to develop interventions to promote
physical activity and reduce health risk. Lack of adequate physical activity is a
significant health problem in children in the United States. While considerable efforts
are underway to understand and address the problem of low physical activity levels in
the general population, there has been little research in children with disabilities. We
propose that children with DCD are at particular risk for low activity, low levels of
fitness and obesity due to the nature of their disorder. DCD is a neurologically-based
developmental disorder characterized by impaired motor coordination that significantly
interferes with academic achievement and activities of daily living. Because of poor
coordination, children with DCD often are unable to participate in sports and physical
activities with their peers. The goals of this study are to test our overarching hypothesis
that children with DCD are less active, more sedentary, and thus are at greater risk for
obesity and lower levels of fitness than children with adequate motor coordination. We
will examine if the association of participation in physical activity and time spent in
sedentary behavior with fitness and with weight status differs between children with
DCD and with adequate motor coordination. We will use state-of-the-art methodology
to measure activity level (accelerometry). We will determine whether children with
DCD show significantly lower overall activity, spend less time in moderate-vigorous
activity and more time in sedentary behavior, have significantly lower levels of physical
fitness and significantly higher BMI z-scores and prevalence of risk for obesity (>85th
percent), than children with average motor coordination. The relationship among
measures will be examined to understand whether physical activity in children with
DCD has the same effect on weight status and fitness as in children with adequate
coordination. This project is responsive to Healthy People 2010 objectives which seek
to increase physical activity among the nation's youth. Children with DCD represent a
substantial number of children in the population who, due to their coordination
disorders, are at even higher risk. The study has broader implications to other children
with special needs such as those with learning disabilities and autism who also have
been identified as having coordination deficits that may limit participation.