The effect of vibration on postural response of Down syndrome individuals on the seesaw

doi:10.1016/j.ridd.2009.02.012

Research in Developmental Disabilities

Volume 30, Issue 6, November–December 2009, Pages 1124-1131

https://doi.org/10.1016/j.ridd.2009.02.012 Get rights and content

Abstract

In order to better understand the role of proprioception in postural adjustments on unstable surfaces, we analyzed the effect of vibration on the pattern of muscle activity and joint displacements (ankle, knee and hip) of eight intellectually normal participants (control group—CG) and eight individuals with Down syndrome (DS) while balancing on seesaws of different heights. The individuals with DS adopted a pattern of co-contraction and were not able to modulate the magnitude of postural response with the seesaw's height. The vibration affected neither the ability of individuals with DS to maintain balance nor the pattern of muscle contraction. On the other hand the control group changed the strategy with vibration, adopting one similar to that used by individuals with DS. Collectively, our findings suggest that proprioceptive information is essential for the motor control system to select the appropriate motor strategy of reciprocal activation among the agonist and antagonist to efficiently balance. Also, these findings suggest that a proprioceptive deficit could explain the atypical motor strategy observed in individuals with DS during balance on seesaw.

Section snippets

Participants

Eight individuals with DS (four males, four females, average age 28.1 ± 4.22 years, average weight 65.3 ± 6.97 kg) and eight age and sex-matched controls (CG) (average age 27.5 ± 5.68, weight 64.3 ± 8.9) were studied after their parents had signed an institutional (UNICAMP) term of informed consent, which was approved by the University of Campinas Ethics Committee, indicating that this study was conducted in accordance with relevant ethical principles. All individuals with DS had good hearing, were able

Results

Fig. 2 shows muscle activation patterns of the gastrocnemius medialis (GM), tibialis anterior (TA) and ankle joint displacement of one control individual and one with DS while balancing on a seesaw 12 cm in height, with and without vibration. The control individual maintained balance using a reciprocal pattern of muscle activation characterized by alternation between ankle agonist and antagonist muscles. The shortcoming of this pattern of muscle activity was observed with vibration of the

Discussion

As previously reported on the seesaw, a typical muscle strategy is used (Almeida, Carvalho, & Talis 2006). This strategy is characterized by balance mainly by the ankle joint with an alternating activation of the TA and GM muscles and by modulating these muscle responses with the degree of the seesaw stability. In this sense, the results presented here by control group are consistent with previous findings.

The vibration of the Achilles tendon decreased the muscle activity and ankle displacement

Conclusion

The individuals with DS adopted less efficient kinematic and EMG strategy to maintain balance on the seesaw. This strategy was not affected by vibration. On the other hand, the control group changed the strategy with vibration, adopting one similar to that used by individuals with DS. Collectively, our findings suggest that proprioceptive information is essential for the motor control system to select the appropriate motor strategy of reciprocal activation among the agonist and antagonist to

Acknowledgement

Authors thank FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO for financial support - (grant no. 98/06866-8).

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Cited by (13)

Center of pressure displacements in individuals with Down syndrome during a bipedal position
2016, Revista Andaluza de Medicina del Deporte
Valorar el equilibrio de adultos con síndrome de Down a través del estudio del desplazamiento del centro de presiones.
Estudio transversal de casos y controles. Doce sujetos con síndrome de Down y 12 sin síndrome de Down formaron parte del estudio. Todos los participantes realizaron 2 pruebas sobre plataforma dinamométrica: i) estática con ojos abiertos y ii) estática con ojos cerrados. Las señales del centro de presiones fueron analizadas en el dominio temporal. Se utilizaron contrastes no paramétricos para el análisis estadístico de los datos.
Los resultados mostraron diferencias significativas entre-grupos en las variables rango anteroposterior, fuerza anteroposterior y fuerza medio-lateral (p < 0.05). Las comparaciones intragrupos mostraron peores resultados en las pruebas con ojos cerrados en ambos grupos.
En el presente trabajo las personas con síndrome de Down presentaron un control del equilibrio mermado al compararlo con sujetos sin síndrome de Down. Los datos obtenidos no son concluyentes para determinar cuál de los sistemas involucrados en el control del equilibrio es el responsable de estos resultados.
To evaluate body balance of adults with Down syndrome based on the analysis of their centre of pressure behaviour.
Cross-sectional case control-study. Twelve individuals with Down syndrome and twelve without Down syndrome took part in the study. All the participants were tested under two conditions on a force plate: i) static with eyes open and ii) static with eyes closed. Centre of pressure signals were analyzed in time domain. Non-parametric contrasts were used for statistical analysis.
Statistical differences between groups were found in anteroposterior range, anterior-posterior force and medio-lateral force (p < 0.05). Within-groups comparisons showed poorer results in eyes closed conditions for both groups.
Individuals with Down syndrome involved in the present study showed deficits in balance control when compared with people without Down syndrome. The obtained data are not conclusive. The participation of the different systems which control balance in people with Down syndrome remains unknown.
Avaliar o equilíbrio de adultos com síndrome de Down através do estudo do desprendimento do centro de pressão.
Estudo transversal de caso e controlos. Doze sujeitos com SD e 12 sem Síndrome de Down fizeram parte do estudo. Todos os participantes realizaram 2 provas sobre plataforma dinamométrica: i) estática com olhos abertos e ii) estática com olhos fechados. Os sinais dos centros de pressões foram analisados em domínio temporal. Foram utilizados testes não paramétricos para a análise estatística dos dados.
Os resultados mostraram diferenças significativas entre grupos nas variáveis de intervalo ântero-posterior, força ântero-posterior e força médio-lateral (p < 0.05). As comparações intragrupos mostram piores resultados nas provas de equilíbrio com olhos fechados para ambos os grupos.
No presente estudo, as pessoas com Síndrome de Down apresentaram um controlo de equilíbrio diminuído em comparação a sujeitos sem Síndrome de Down. Os dados obtidos não são conclusivos para determinar qual dos sistemas envolvidos no controlo do equilíbrio é responsável por estes resultados.
Integrated effect of treadmill training combined with dynamic ankle foot orthosis on balance in children with hemiplegic cerebral palsy
2015, Egyptian Journal of Medical Human Genetics
Maintaining balance is a necessary requirement for most human actions. Most cerebral palsy children, who constitute a large portion in our country, continue to evidence deficits in balance, co-ordination, and gait throughout childhood. So, the purpose of this study was to determine the combined effects of treadmill and dynamic ankle foot orthosis on balance in spastic hemiplegic children.
Thirty spastic hemiplegic children from both sexes ranging in age from 7 to 11 years represented the sample of the study. The degree of spasticity ranged from 1 to 1+ according to the Modified Ashworth Scale. They were assigned randomly into two groups of equal number (A and B). Each child in the two groups was evaluated before and after 3 months of treatment for detecting the level of lower limb performance using the Peabody Developmental Test of Motor Proficiency and Stability indices using Biodex instrument system.
Both groups received a designed physical therapy program for treatment of hemiplegic cerebral palsy children for 60 min, in addition group B received treadmill training with dynamic ankle foot orthoses for 30 min.
Significant improvements were observed in all measuring variables when comparing the pre and post-in the same group. Comparing the post-treatment variables, significant difference is revealed in favor of the group (B).
The obtained results strongly support the combined effect of dynamic AFO with treadmill training as an additional procedure to the treatment program of hemiplegic cerebral palsy children.
Effect of vibration versus suspension therapy on balance in children with hemiparetic cerebral palsy
2012, Egyptian Journal of Medical Human Genetics
Most cerebral palsy children have deficits in balance, co-ordination, and gait throughout childhood and adulthood. So, it is essential to seek an ideal physical therapy program to help in solving such widespread problem. The present study was conducted to compare between the effect of vibration training and suspension therapy on balance in children with hemiparetic cerebral palsy.
Thirty children born with hemiparetic cerebral palsy from both sexes ranging in age from eight to ten years old were assigned into two groups of equal number. Study group I received vibration training in addition to a designed physical therapy program and study group II received suspension therapy in addition to the same physical therapy program given to the study group I. Stability indices were evaluated via using Biodex instrument system before and after six months of treatment.
The results revealed no significant difference when comparing the pre-treatment mean values of the two groups (study I and study II), while significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post treatment mean values. Significant difference was also observed when comparing the post treatment results of the two groups in favor of the study group II.
Suspension therapy for children with hemiparetic cerebral palsy is an excellent supplement to regularly scheduled physical therapy intervention for the purpose of improving degree of stability in those patients.
Role of treadmill training versus suspension therapy on balance in children with Down syndrome
2012, Egyptian Journal of Medical Human Genetics
Citation Excerpt :
Improvement fulfilled in the study groups I and II might be attributed to the effect of exercises therapy program for balance and postural control. This agrees with the findings of Carvalho and Almeida [31] who suggested that proprioceptive information is essential for the motor control system to select the appropriate motor strategy of reciprocal activation among the agonist and antagonist to efficiently maintain balance. Significant difference was observed when comparing the post-treatment results of the two groups in the favor of the study group II receiving suspension therapy via using spider cage.
Maintaining balance is a subordinate but necessary requirement for most human actions. Most Down syndrome (DS) children, who constitute a large portion in our country, continue to evidence deficits in balance, co-ordination, and gait throughout childhood and adulthood. So, it is essential to seek an ideal physical therapy program to help in solving such a widespread problem. The present study was conducted to compare between the effect of treadmill training and suspension therapy on balance in children with DS.
Thirty children born with DS from both sexes ranging in age from eight to ten years old were assigned into two groups of equal number. Study group I received treadmill training in addition to a designed exercises therapy program and study group II received suspension therapy in addition to the same exercises program given to the study group I. Stability indices were evaluated via using Biodex instrument system before and after three months of treatment.
The results revealed no significant difference when comparing the pre-treatment mean values of the two groups (study I and study II), while significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post treatment mean values. Significant difference was also observed when comparing the post treatment results of the two groups in favor of the study group II.
Suspension therapy for children with DS is an excellent supplement to regularly scheduled physical therapy intervention for the purpose of improving the degree of stability in those patients.
The effect of galvanic vestibular stimulation on postural response of Down syndrome individuals on the seesaw
2011, Research in Developmental Disabilities
Citation Excerpt :
Also the GVS affected neither the ability of CG individuals to maintain balance nor the alternated pattern of muscle contraction. The results presented here by CG and by individuals with DS without GVS are consistent with previous findings (Almeida, Carvalho, & Talis, 2006; Carvalho & Almeida, 2009a, 2009b). The CG maintained their balance mainly by the ankle joint with an alternating activation of the TA and GM muscles.
In order to better understand the role of the vestibular system in postural adjustments on unstable surfaces, we analyzed the effects of galvanic vestibular stimulation (GVS) on the pattern of muscle activity and joint displacements (ankle knee and hip) of eight intellectually normal participants (control group – CG) and eight control group individuals with Down syndrome (DS) while balancing on seesaws of different heights. The CG individuals adopted a pattern of muscle activation characterized by alternation between ankle agonist and antagonist muscles. The individuals with DS adopted a pattern of muscle co-contraction. The GVS affected neither the ability of CG individuals to maintain balance nor their pattern of muscle contraction. On the other hand, the individuals with DS showed greater sensitivity to GVS while balancing on a seesaw and were not able to select the appropriate motor strategy to efficiently balance and compensate the effects of GVS. These increased vestibular sensitivities observed in individuals with DS can reflect deficits in the proprioceptive system.
Postural strategies in Prader-Willi and Down syndrome patients
2011, Research in Developmental Disabilities
Citation Excerpt :
PWS were in fact characterised by values closer to normal than DS and were able to walk with a more “stable” strategy (Cimolin et al., 2010). Postural analysis has also been investigated mainly in DS (Carvalho & Almeida, 2009; Galli, Rigoldi, Mainardi et al., 2008; Shumway-Cook & Woollacott, 1985; Webber, Virji-Babul, Edwards, & Lesperance, 2004) and, to our knowledge, only one study was conducted on PWS patients (Capodaglio et al., 2010). According to this literature, both DS and PWS are characterised by a reduced postural control, as measured by center of pressure displacement (CoP) and postural sway velocity.
Patients affected by Down (DS) and Prader–Willi syndrome (PWS) are characterised by some common clinical and functional features including gait disorders and reduced postural control. The aim of our study was to quantitatively compare postural control in adult PWS and DS.
We studied 12 PWS and 19 DS adult patients matched for age, height, weight and body mass index.
They were instructed to maintain an upright standing position on a force platform for 30 s with open eyes (OE) and we calculated the range of center of pressure (CoP) displacement in the A/P direction (RANGE_AP) and in the M/L direction (RANGE_ML) and the total CoP trajectory length during quiet stance (Sway Path, SP).
The range of oscillations in PWS and DS in both AP and ML direction were higher than in controls. PWS and DS were statistically different for RANGE_AP, with PWS showing higher mean values.
Our results confirm a reduced capacity of both PWS and DS in maintaining postural stability. This appears to be in some respect different in PWS and DS, with PWS showing poorer control in AP. DS and, particularly, PWS should be encouraged to undergo specific balance training and strengthening of the ankle muscles as part of a comprehensive rehabilitation program to enhance daily functioning and quality of life.

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View full text

The effect of vibration on postural response of Down syndrome individuals on the seesaw

Abstract

Section snippets

Participants

Results

Discussion

Conclusion

Acknowledgement

Postural strategy to keep balance on the seesaw

Gait and Posture

A coactivation strategy in anticipatory postural adjustments in person with Down syndrome

Motor Control

Neuropsychological, neurological, and neuroanatomical profile of Williams syndrome

American Journal of Medical Genetics

Propriocepsis in the lower legs: Is it essential for triggering human balance corrections

Experimental Brain Research

Impaired peripheral somatosensory function in children with Down syndrome

Neuropediatrics

Deficits in the production of grip force in Down syndrome

Developmental Medicine and Child Neurology

Human body-segment tilts induced by galvanic stimulation: A vestibularly driven balance protection mechanism

Journal of Physiology

Task-dependent reflex responses and movement illusions evoked by galvanic vestibular stimulation in standing humans

Journal of Physiology

Postural control in patients with Down syndrome

Disability Rehabilitation

Postural control in Down syndrome: The use of somatosensory and visual information to attenuate body sway

Motor Control

The integration of multiple proprioceptive information: Effect of ankle tendon vibration on postural responses to platform tilt. Experimental

Brain Research