Volume 7, Issue 2 (8-2021)                   J Sport Biomech 2021, 7(2): 136-147 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Azimizadeh M J, Hoseini S H, Norasteh A A. Effect of a Combined Strengthening and Proprioceptive Training Program on Balance and Gait of Female Children With Intellectual Disability. J Sport Biomech. 2021; 7 (2) :136-147
URL: http://biomechanics.iauh.ac.ir/article-1-250-en.html
1- Department of Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Guilan, Iran.
2- Department of Physical Education and Sport Sciences, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Guilan, Iran.
Full-Text [PDF 6239 kb]   (255 Downloads)     |   Abstract (HTML)  (660 Views)
Full-Text:   (284 Views)
1. Introduction
hildren with special needs are defined as children who are different from normal children in several dimensions, including physical, cognitive, and psychological, and are not able to use the facilities. Children with intellectual disabilities are children who have physical and mental disabilities and are mentally less intelligent than their normal peers [2]. They have an inability to learn or delayed reading, writing and arithmetic abilities and are associated with delayed speaking and low language development. The prevalence of intellectual disability is about 3-13% of the world’s population, and 75-90% of these people have a mild or educable intellectual disability. 4.6% of people under 18 years of age in developing countries and 0.5-2.5% of people in developed countries have intellectual disability. In terms of education, these people are divided into the group of slow learners (IQ=75-90), educable (IQ=50-70), trainable group (IQ=25-50) and custodial (IQ <25). In total, intellectual disability is more common in males [2]. Common known features in people with intellectual disability are: obesity, muscle weakness, postural deviation, impaired balance, vision problems, hearing problems, and physical disability. It should be noted that some of the mentioned features such as obesity are due to inactivity which causes a high prevalence of mortality among these people [4]. People with intellectual disability have lower scores on motor perceptual tests than normal individuals due to impaired sensory-motor information integrity, and their balance is more unstable than healthy peers [5]. There are several factors involved in the development of intellectual disability in children including hereditary factors or causes related to before the formation of the fetus, pre-delivery causes or factors related to pregnancy such as medication use, maternal infection, etc., and causes during delivery, the most common cause of which is premature birth. Some factors after birth also can lead to mental retardation of the child [6]. The educable mentally retarded children have lower physical strength, endurance level, agility, running speed, reaction time and balance compared to normal peers. 
They are 2-4 years behind normal children in doing motor activities. Hoffman in assessing children who learn things faster (both girls and boys) compared to slow learners, found that mentally retarded female children are superior in their ability to perform balance movements [6]. The ability of individuals to maintain balance is essential to the successful completion of all movements. Static and dynamic balances have been proven to be very important in a child’s life. Since the fall is a recurring event in people with intellectual disabilities, balance is more important in mentally retarded children. Movement is the most basic means of communication with the outside world and the first reaction by which a person can realize the process of adaptation. Developing motor skills through motor activities, in addition to gaining coordination, causes calmness, stability of behavior and relaxation. In people with mental disabilities, movement and physical health have a special importance and role in areas such as daily activities, educational activities, social relations, self-confidence and self-concept. Moreover, the quantity and quality of movement is directly related to the overall growth rate of the individual. Since children with intellectual disability go through the stages of motor development irregularly and with delay, it seems necessary to include motor activities in their daily routine. Given that intellectual disability is not curable, the main task of this group of patients is rehabilitation and education.
2. Methods
This is a quasi-experimental study with pre-test/post-test design using a control group. Participants were 24 educable mentally retarded female students in Dr. Sajjadi elementary school located in Mashhad, Iran aged 9-13 years (IQ=50-70). Students with obvious physical disabilities or behavioral disorders, as well as those with Down syndrome, were excluded from the study. After additional explanations on how to perform the exercise, written informed consent was obtained from the children’s parents. Stork test was used to assess static balance, TUG test for dynamic balance, 50-m walk test for walking speed, and chair stand test for lower limb power. Paired t-test was used to examine the differences between pre-test and post-test scores in the two groups separately, , For statistical analysis, ANCOVA was used in SPSS v.16 software. Significance level was set at 0.05.
3. Results
According to Tables 1 and 2, Paired t-test results showed a significant difference between pre-test and post-test scores in static and dynamic balances in the exercise group (p<0.05), while there was no significant difference in the control group. 




Therefore, it can be said that the exercise program caused a significant progress in static and dynamic balance of children.
4. Discussion and conclusion
The purpose of this study was to investigate the effect of an eight-week of strengthening and proprioceptive training program on balance, lower limb strength and gait speed of mentally retarded female children. Strength and proprioception exercises are known as one of the effective training methods in preventing damage and strengthening the proprioception system, nerves and muscles. Considering that the training program had an effect on the core stability, strengthening the muscles in this area had a great effect on the center of gravity of mentally retarded children. It improved the neuromuscular system, coordinated and strengthened the core muscles, caused the displacement of the center of gravity, brought the line of gravity closer to the axis of the joints, and reduced the torque created in the joints. As a result, it maintained the stability of the body’s center of gravity in the base of support and increased static balance. The results of the present study indicate that combined exercises increase the level of physical fitness in mentally retarded children, and cause muscle activation and increased rate of muscle contraction. On the other hand, it stimulates the proprioception system, which is one of the parameters of balance, and increases the balance capacity of female children with intellectual disabilities.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured abou the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This study was extracted from the master thesis of first author approved by University of Guilan

Authors' contributions
All authors contributed equally in preparing this article

Conflicts of interest
The authors declare no conflict of interest

Acknowledgements
The authors would like to thank the parents of children participated in this study for their cooperation


Refrences
  1. Taghian H, Ghasemi GA, Sadeghi M. [Effect of combined exercises (strength and balance) on balance and aggression in 7-14 year-old educabe intelectual disability boys (Persian)]. Sci J Rehabil Med. 2017; 6(3):174-81. [DOI:10.22037/JRM.2017.1100363]
  2. Afrooz GA. [Introduction to psychology and education of mentally retarded children (Persian)]. Tehran: University of Tehran Press; 1986. http://opac.nlai.ir/opac-prod/bibliographic/1846755
  3. Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major health risks in aging persons with intellectual disabilities: An overview of recent studies. J Policy Pract Intellect Disabil. 2010; 7(1):59-69. [DOI:10.1111/j.1741-1130.2010.00248.x]
  4. Walsh D, Belton S, Meegan S, Bowers K, Corby D, Staines A, et al. A comparison of physical activity, physical fitness levels, BMI and blood pressure of adults with intellectual disability, who do and do not take part in Special Olympics Ireland programmes: Results from the SOPHIE study. J Intellect Disabil. 2018; 22(2):154-70. [DOI:10.1177/1744629516688773] [PMID]
  5. Pitchford EA, Dixon-Ibarra A, Hauck JL. Physical activity research in intellectual disability: A scoping review using the behavioral epidemiological framework. Am J Intellect Dev Disabil. 2018; 123(2):140-63. [DOI:10.1352/1944-7558-123.2.140] [PMID]
  6. Rostami R, Rezaie M, Jabari S. [The effectiveness of social-comparative feedback on the performance of power generation task in educable mentally retard girls (Persian)]. Psychol Except Individ. 2015; 5(18):123-39. [DOI:10.22054/JPE.2015.1548]
  7. Zare S, Rahnama N, Movahedi AR. [The effect of balance exercises on static and dynamic balance of the mentally retarded female students (Persian)]. J Exerc Sci Med. 2017; 8(2):143-58. [DOI:10.22059/JSMED.2017.62303]
  8. Roshandel Hesari A, Daneshi Nejad MH, Jafari M. [Effect of perceptual-motor training on static balance in mentally retarded children (Persian)]. Paramed Sci Mil Health. 2017; 12(1):12-7. http://jps.ajaums.ac.ir/article-1-104-en.html
  9. Alikhani R, Shahrjerdi Sh, Golpaigany M, Kazemi M. The effect of a six-week plyometric training on dynamic balance and knee proprioception in female badminton players. J Can Chiropr Assoc. 2019; 63(3):144-53. [PMID] [PMCID]
  10. Oviedo GR, Guerra-Balic M, Baynard T, Javierre C. Effects of aerobic, resistance and balance training in adults with intellectual disabilities. Res Dev Disabil. 2014; 35(11):2624-34. [DOI:10.1016/j.ridd.2014.06.025] [PMID]
  11. Dehghani M, Gunay M. The effect of balance training on static and dynamic balance in children with intellectual disability. J Appl Environ Biol Sci. 2015; 5(9):127-31. https://www.researchgate.net/profile/Mahrokh-Dehghani/publication/343059419
  12. Lee K, Lee M, Song C. Balance training improves postural balance, gait, and functional strength in adolescents with intellectual disabilities: Single-blinded, randomized clinical trial. Disabil Health J. 2016; 9(3):416-22. [DOI:10.1016/j.dhjo.2016.01.010] [PMID]
  13. Zolghadr H, Sedaghati P, Daneshmandi H. The effect of selected balance/corrective exercises on the balance performance of mentally-retarded students with developmental coordination disorder. Phys Treat. 2019; 9(1):23-30. [DOI:10.32598/PTJ.9.1.23]
  14. Bahiraei S, Daneshmandi H, Norasteh A, Sokhangoei Y. [The study of biomechanical gait characteristics in intellectual disabilities: A systematic review (Persian)]. J Health Promot Manage. 2019; 8(1):1-11. http://jhpm.ir/article-1-974-en.html
  15. Hoseini SA, Zar A, Khodadoust M, Hejazi E. [The effect of eight weeks posture and balance trainings on physical fitness factors of mental retardation children (Persian)]. Iran J Pediatr Nurs. 2017; 3(3):26-31. [DOI:10.21859/jpen-03035]
  16. Daneshmandi H, Alizadeh MH, Gharakhanlo R. [Corrective exercises (diagnosis and prescription of exercises) (Persian)]. Tehran: SAMT; 2013. http://opac.nlai.ir/opac-prod/bibliographic/3311312
  17. Oseloka IA, Bello BM, Oliver HW, Emmanuel UU, Abraham MS. Association of handgrip strength with body mass index among Nigerian students. J Pharm Biol Sci. 2014; 9(1):1-7. [DOI:10.9790/3008-09160107]
  18. Elmahgoub SM, Lambers S, Stegen S, Van Laethem C, Cambier D, Calders P. The influence of combined exercise training on indices of obesity, physical fitness and lipid profile in overweight and obese adolescents with mental retardation. Eur J Pediatr. 2009; 168(11):1327-33. [DOI:10.1007/s00431-009-0930-3] [PMID]
  19. Blomqvist S, Olsson J, Wallin L, Wester A, Rehn B. Adolescents with intellectual disability have reduced postural balance and muscle performance in trunk and lower limbs compared to peers without intellectual disability. Res Dev Disabil. 2013; 34(1):198-206. [DOI:10.1016/j.ridd.2012.07.008] [PMID]
  20. Shields N, Taylor NF. A student-led progressive resistance training program increases lower limb muscle strength in adolescents with Down syndrome: A randomised controlled trial. J Physiother. 2010; 56(3):187-93. [DOI:10.1016/S1836-9553(10)70024-2] [PMID]
  21. Calders P, Elmahgoub S, de Mettelinge TR, Vandenbroeck Ch, Dewandele I, Rombaut L, et al. Effect of combined exercise training on physical and metabolic fitness in adults with intellectual disability: A controlled trial. Clin Rehabil. 2011; 25(12):1097-108. [DOI:10.1177/0269215511407221] [PMID]
  22. Giagazoglou P, Kokaridas D, Sidiropoulou M, Patsiaouras A, Karra C, Neofotistou K. Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities. Res Dev Disabil. 2013; 34(9):2701-7. [DOI:10.1016/j.ridd.2013.05.034] [PMID]
  23. Salehzadeh K, Esrafilzadeh S. [Effects of an eight-week pilates exercise program on some physical fitness factors and kinetic performance in girl students with intellectual disability (Persian)]. J Res Rehabil Sci. 2016; 12(5):259-66. http://jrrs.mui.ac.ir/index.php/jrrs/article/view/2747
  24. Kubilay NS, Yildirim Y, Kara B, Harutoglu Akdur H. Effect of balance training and posture exercises on functional level in mental retardation. Fizyoterapi Rehabilitasyon. 2011; 22(2):55-64. https://dergipark.org.tr/en/download/article-file/138090
  25. Damian M, Gevat C, Stanculescu G, Larion A. Improvement of motor performance of students with mentally retardation. Selçuk Univ J Phys Educ Sport Sci. 2010; 12(1):23-8. https://arastirmax.com/tr/system/files/dergiler/20631/makaleler/12/1/arastirmax-improvement-motor-performance-students-mentally-retardation.pdf
  26. Serag SMM. Effects of inclusion in a recreational sports program on improving some basic motor skills and health behavior for mentally retarded (able to learn) and normal children. World J Sport Sci. 2010; 3(S):605-16. https://idosi.org/wjss/3(S)10/71.pdf
  27. Yildirim NÜ, Erbahçeci F, Ergun N, Pitetti KH, Beets MW. The effect of physical fitness training on reaction time in youth with intellectual disabilities. Percept Mot Skills. 2010; 111(1):178-86. [DOI:10.2466/06.10.11.13.15.25.PMS.111.4.178-186] [PMID]
Type of Study: Research | Subject: Special
Received: 2021/05/13 | Accepted: 2021/07/21 | Published: 2021/09/1

References
1. Taghian H, Ghasemi GA, Sadeghi M. Effect of combined exercises (strength and balance) on balance and aggression in 7-14 year-old educabe intelectual disability boys. Scientific Journal of Rehabilitation Medicine. 2017 Jan 1;6(3):174-81.
2. Afroz G. Introduction to Psychology and Education of Mentally Retarded Children. Tehran. Tehran University Press; 2008.
3. Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major health risks in aging persons with intellectual disabilities: an overview of recent studies. Journal of Policy and Practice in Intellectual Disabilities. 2010 Mar;7(1):59-69. [DOI:10.1111/j.1741-1130.2010.00248.x]
4. Walsh D, Belton S, Meegan S, Bowers K, Corby D, Staines A, McVeigh T, McKeon M, Hoey E, Trépel D, Griffin P. A comparison of physical activity, physical fitness levels, BMI and blood pressure of adults with intellectual disability, who do and do not take part in Special Olympics Ireland programmes: Results from the SOPHIE study. Journal of Intellectual Disabilities. 2018 Jun;22(2):154-70. [DOI:10.1177/1744629516688773] [PMID]
5. Pitchford EA, Dixon-Ibarra A, Hauck JL. Physical activity research in intellectual disability: A scoping review using the behavioral epidemiological framework. American journal on intellectual and developmental disabilities. 2018 Mar;123(2):140-63. [DOI:10.1352/1944-7558-123.2.140] [PMID]
6. Rostami R, Rezaie M, Jabari S. The Effectiveness of Social-Comparative Feedback on the Performance of Power Generation Task in Educable Mentally Retard Girls. Psychology of Exceptional Individuals. 2015 Jun 22;5(18):123-39.
7. Rahnama N, Movahedi AR. The effect of balance exercises on static and dynamic balance of the mentally retarded female students. Journal of Exercise Science and Medicine. 2016 Oct 22;8(2):143-58.
8. Daneshi Nejad MH, Jafari M. Effect of Perceptual-Motor Training on Static Balance in Mentally Retarded Children. Paramedical Sciences and Military Health. 2017 Jun 10;12(1):12-
9. Alikhani R, Shahrjerdi S, Golpaigany M, Kazemi M. The effect of a six-week plyometric training on dynamic balance and knee proprioception in female badminton players. The Journal of the Canadian Chiropractic Association. 2019 Dec;63(3):144.
10. Oviedo GR, Guerra-Balic M, Baynard T, Javierre C. Effects of aerobic, resistance and balance training in adults with intellectual disabilities. Research in developmental disabilities. 2014 Nov 1;35(11):2624-34. [DOI:10.1016/j.ridd.2014.06.025] [PMID]
11. 11 Dehghani M, Gunay M. The effect of balance training on static and dynamic balance in children with intellectual disability. J. Appl. Environ. Biol. Sci. 2015;5(9):127-31. [DOI:10.5958/2249-7315.2015.00108.2]
12. Lee K, Lee M, Song C. Balance training improves postural balance, gait, and functional strength in adolescents with intellectual disabilities: Single-blinded, randomized clinical trial. Disability and health journal. 2016 Jul 1;9(3):416-22. [DOI:10.1016/j.dhjo.2016.01.010] [PMID]
13. 13 Zolghadr H, Sedaghati P, Daneshmandi H. The Effect of Selected Balance/Corrective Exercises on the Balance Performance of Mentally-Retarded Students With Developmental Coordination Disorder. Physical Treatments-Specific Physical Therapy Journal. 2019 Jan 10;9(1):23-30. [DOI:10.32598/PTJ.9.1.23]
14. Sokhangoei Y. The Study of Biomechanical Gait Characteristics in Intellectual Disabilities: A Systematic Review. Journal of Health Promotion Management. 2019 Mar 10;8(1):1-1
15. Hoseini SA, Zar A, Khodadoust M, Hejazi E. The Effect of Eight Weeks Posture and Balance Trainings on Physical Fitness Factors of Mental Retardation Children. Journal of Pediatric Nursing. 2017 Apr 10;3(3):26-31. [DOI:10.21859/jpen-03035]
16. Daneshmandi H, Alizadeh M, Gharakhanlo R. Corrective exercises (diagnosis and prescription). 11st ed. Tehran, Iran: SAMT Publication 2013: 12-17.[In Persian].
17. Oseloka IA, Bello BM, Oliver HW, Emmanuel UU, Abraham MS. Association of handgrip strength with body mass index among Nigerian students. IOSR-JPBS. 2014 Feb;9:1-7. [DOI:10.9790/3008-09160107]
18. Elmahgoub SM, Lambers S, Stegen S, Van Laethem C, Cambier D, Calders P. The influence of combined exercise training on indices of obesity, physical fitness and lipid profile in overweight and obese adolescents with mental retardation. European journal of pediatrics. 2009 Nov 1;168(11):1327. [DOI:10.1007/s00431-009-0930-3] [PMID]
19. Blomqvist S, Olsson J, Wallin L, Wester A, Rehn B. Adolescents with intellectual disability have reduced postural balance and muscle performance in trunk and lower limbs compared to peers without intellectual disability. Research in Developmental Disabilities. 2013 Jan 1;34(1):198-206. [DOI:10.1016/j.ridd.2012.07.008] [PMID]
20. Shields N, Taylor NF. A student-led progressive resistance training program increases lower limb muscle strength in adolescents with Down syndrome: a randomised controlled trial. Journal of physiotherapy. 2010 Jan 1;56(3):187-93... [DOI:10.1016/S1836-9553(10)70024-2]
21. Oviedo GR, Guerra-Balic M, Baynard T, Javierre C. Effects of aerobic, resistance and balance training in adults with intellectual disabilities. Research in developmental disabilities. 2014 Nov 1;35(11):2624-34 [DOI:10.1016/j.ridd.2014.06.025] [PMID]
22. Giagazoglou P, Kokaridas D, Sidiropoulou M, Patsiaouras A, Karra C, Neofotistou K. Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities. Research in developmental disabilities. 2013 Sep 1;34(9):2701-7. [DOI:10.1016/j.ridd.2013.05.034] [PMID]
23. Salehzadeh K, Esrafilzadeh S. Effects of an Eight-Week Pilates Exercise Program on Some Physical Fitness Factors and Kinetic Performance in Girl Students with Intellectual Disability. Journal of Research in Rehabilitation Sciences. 2017 May 20;12(5):259-66.
24. Kubilay NS, Yildirim Y, Kara B, Harutoglu Akdur H. Effect of balance training and posture exercises on functional level in mental retardation. Fizyoterapi Rehabilitasyon. 2011;22(2):55-64.
25. Damian M, Gevat C, Stanculescu G, Larion A. Improvement of motor performance of students with mentally retardation. Selçuk University Journal of Physical Education and Sport Science. 2010;12(1):23-8.
26. Sobhy Mohamed Mohamed Serag. (2010). Effects of inclusion in a recreational sports program on improving some basic motor skills and health behavior for mentally retarded (able to learn) and normal children. World Journal of Sport Sciences 3(S): 605-616
27. Yildirim NÜ, Erbahçeci F, Ergun N, Pitetti KH, Beets MW. The effect of physical fitness training on reaction time in youth with intellectual disabilities. Perceptual and motor skills. 2010 Aug;111(1):178-86. [DOI:10.2466/06.10.11.13.15.25.PMS.111.4.178-186] [PMID]

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2022 CC BY-NC 4.0 | Journal of Sport Biomechanics

Designed & Developed by : Yektaweb