Subject Areas : Report of Health Care
Soleiman Salimi Asl 1 , Ali yalfani 2
1 - Department of Sports Pathology, Islamic Azad University, Khorasgan Branch, Khorasgan, Isfahan
2 - Department of Sports Pathology, Islamic Azad University, Khorasgan Branch, Khorasgan, Isfahan
Keywords:
Abstract :
The effect of eight weeks of trampoline training on the balance and muscle strength of men with Down syndrome
Abstract
Introduction: Weakness in muscle function is one of the most common complications of Down syndrome and is associated with delayed motor growth and decreased muscle function. On the other hand, the role of exercise in improving strength is well known. Therefore, the present study aimed to investigate the effect of eight weeks of trampoline training on balance and muscle strength of men with Down syndrome.
Methods: In this quasi-experimental study, 24 people with Down syndrome (age: 26.8±45.26) were randomly divided into two groups: training and control. The study variables of static and dynamic balance and explosive strength of the subjects were measured before and after the training period respectively, by the stork balance stand test, dynamic Y balance, and Sargent vertical jump. For eight weeks, the subjects performed three 30-minute trampoline sessions each week. Dependent sample t-test statistical method was used for inferential data analysis (p ≥ 0.05).
Results: Eight weeks of trampoline training had a significant effect on increasing peak strength (p = 0.01), mean strength (p = 3.12), and dynamic Y balance in the anterior (p = 0.001) and external posterior (p = 001) direction in individuals with Down syndrome, but has no significant effect on increasing static balace (p = 0.26) and dynamic Y balance in the internal posterior direction (P = 0.28).
Conclusion: Based on the findings of the study, the use of trampoline training in the process of physical rehabilitation of patients with Down syndrome is recommended.
Keywords: Down syndrome, trampoline, static balance, dynamic balance, muscle strength
Introduction
Down syndrome is one of the most common chromosomal disorders in which the chromosome pair 21 suffers from trisomy, and as a result, the person contracts developmental and neuro-physiological disorders. Therefore, participation in moderate to high intensity physical activity in these patients is much lower than in their healthy peers. People with Down syndrome have differences with others, some of which are related to physical characteristics and some to mental characteristics (1).
Down syndrome is associated with more than 50 complications (2). Various studies have shown that muscle relaxation and weakness in muscle function are included in the most common complications of Down syndrome associated with delayed motor growth and decreased muscle function, and muscle function is a basic ability that plays a very important role in performing everyday activities and general health of these people; and muscle weakness leads to reduced quality of life, the need for care services and ultimately the need for long-term and permanent care (3). Also, this muscle weakness reduces mobility, causes obesity and creates problems in performing daily tasks and reduces the quality of life in these people (3). Therefore, balance is one of the important factors of physical fitness that is examined as dynamic and static balance and hence people with Down syndrome have an important delay in developing motor skills and balance, which is obvious during childhood and adulthood (4). A study showed that compared to the general population and other mentally handicapped people, people with Down syndrome are at a lower level of balance (3).
Determining and applying safe, appropriate, and low-cost methods is essential to assessing and treating the parameters associated with falling in Down syndrome patients. The use of physical exercise as an inexpensive, affordable, non-invasive, and low-risk device has been accepted and recommended in maintaining good health and mobility, and maintaining or restoring balance and preventing falls (5).
Many studies have been done in this field, for example, eight weeks, three sessions per week and 120 minutes per session of exercises such as swinging, jumping on a trampoline, turning the child around himself/herself, turning the child around the trainer, etc.) improved reaction time, dynamic balance and static balance in children with motor developmental disorders (6). Sixteen 45-minute sessions of core stability training improved the balance of children with Down syndrome (7); 6 weeks, three sessions per week of progressive resistance training significantly increased the balance of children with Down syndrome (8); but eight weeks, three sessions per week of training on the rebounder had no significant effect on improving static and dynamic balance in these students (9).
One of the ways to improve balance and prevent falls is to do trampoline training. The use of trampoline training (romping therapy) as a low-cost, affordable, non-invasive, and low-risk device for maintaining health and mobility and preventing people from having Down syndrome has been accepted (5). And because balance and posture problems make people with Down syndrome withdraw from sports activities and daily life movements, it is essential to provide motor programs to improve their skills and quality of life.
In recent years, interest in assessing and improving the quality of life of patients has increased significantly, and improving the quality of daily activities and quality of life of these people has become a goal. The impact of this type of problems on quality of life is one of the issues that should be considered. Due to the existence of various stressors in the lives of these patients, long-term physical and mental problems in the lives of these people are more likely to reduce their quality of life. Therefore, considering the above factors and the importance of quality of life of Down syndrome patients due to their high population compared to other mentally retarded people and the importance of motor exercise in improving the condition of these people, the present study aims to investigate the effect of eight weeks of trampoline training on the stature, muscle strength and quality of life of men with Down syndrome.
Methodology
In this semi-experimental study with pre-test-post-test design and control group, 24 men with Down syndrome and an average age (26.8 ± 45.26) in Bahar Institute of Down Syndrome in Abadeh were selected as the subjects of the study based on convenient purposeful sampling.
The subjects' inclusion criteria comprised no apparent motor impairment, IQ between 60 and 75, ability to communicate with others, and not having diseases to be exacerbated by physical activity (epilepsy, heart disease, diabetes, and spinal problems). The exclusion criteria also included not attending 3 training sessions as well as withdrawing parents or custodians from continuing their child's activities. Afterwards, in a briefing session with the presence of patients’ custodians, all the necessary points and research steps were presented. It is noteworthy that the written consent form for participation in the study was completed by the subjects’ custodians. The subjects were then randomly assigned to control and training groups, and the training group performed eight weeks of trampoline training (10), three sessions per week and 30 minutes each session.
To measure the balance, static balance test (standing on one leg with eyes closed and open) and dynamic balance test (dynamic balance modified as " Y balance test") and to measure the strength, Sargent jump test in pre-test and 24 hours after the last training session were used. To analyze the research findings in the pre-test and post-test, paired sample t-test and independent sample t-test were used in SPSS software version 22 (p ≥0.05).
Findings
The demographic characteristics of the research are presented in Table 1. The results of the Shapiro-Wilk test showed that the distribution of research findings in the pre-test and post-test was normal.
The results of the paired t-test to examine the difference between pre-test and post-test of each group showed that the duration of standing on one leg (stork test) (p = 0.30) (Figure 1), Sargent jump test (p = 0.97). (Figure 2), internal posterior Y test (p = 0.14) (Figure 3) and external posterior (p = 0.55) (Figure 4) did not differ significantly in the pretest and posttest of the control group. However, the score of the anterior Y test (Figure 5) significantly decreased in the posttest test of the control group compared to the pre-test (p = 0.03). Also, the results of dependent sample t-test showed that the balance time in the stork test (p = 0.04), Sargent jump (p = 0.01), Y test in the anterior direction (p = 0.001) and Y test in the external posterior direction (p = 0.001) had a significant increase in the post-test of the training group compared to the pre-test. However, no significant difference was observed in the pre-test and post-test of the Y-test in the internal posterior direction (p = 0.28).
Also, in order to investigate the difference between the groups, first the difference between pre-test and post-test of variables was calculated and independent sample t-test was calculated out of its difference. The results of independent sample t-test showed that the scores of Sargent jump test (p = 0.008), Y test in the anterior direction (p = 0.001) and Y test in the external posterior direction (p = 0.001) in the training group were significantly higher than the control group. However, there was no significant difference in the stork test (p = 0.19) and Y test in the internal posterior direction (p = 0.13) in the training and control groups.
Table 1. Mean and standard deviation of demographic characteristics of research participants | ||||
Group | Age (year) | Hight (cm) | Weight (kg) | |
training |
| 26.45±8.26 | 154.18±6.49 | 54.45.49±7.95 |
control |
| 27.00±6.88 | 157.18±5.38 | 57.09±6.45 |
Figure 1. Duration of balance retention in the stork test in the pre-test and post-test of the research groups
Figure 2. Levels of Sargent jump test in the pre-test and post-test of research groups
** (p = 0.008) increase in the training group compared to the control group
Figure 3. Levels of Y-test in the internal posterior direction in the pre-test and post-test of the research groups
*** (p = 0.001) increase in the training group compared to the control group
Figure 5. Levels of Y-test in the anterior direction in the pretest and post-test of the research groups
*** p = (0.001) increase in the training group compared to the control group
Discussion
Research has shown that eight weeks of trampoline training has a significant effect on the dynamic balance of people with Down syndrome, but does not have a significant effect on increasing static balance and dynamic Y balance in the internal posterior direction.
The training protocol did not improve static balance in these individuals. The results of this finding are inconsistent with the results of Shahbazi et al.'s study, probably due to differences in the statistical population and the trampoline exercise.
Balance control requires participation in the three areas of information processing through the visual, atrial, and somatic senses, central integration in the brain, and motor response. Any failure in the above system can cause a person's exposure to falling situations (6, 8).
This decrease in balance is exacerbated by inactivity and a decrease in muscle strength, and studies have reported that physical activity can improve postural control and reduce falls (6). The results of this study are consistent with the results of the research of Sayadinejad et al. who examined the effect of progressive resistance training on the functional balance of Down syndrome children who received progressive resistance training for 6 weeks and three sessions per week (8).
Strength is an important aspect of motion control. According to systems theory, the ability to control the state of the body in space is due to the complicated interaction of the nervous system and the musculoskeletal system, collectively called the posture control system. This system requires balance retention and subsequent movement to interfere with internal sensory nerve data in order to detect the position of the body in space, as well as the ability of the musculoskeletal system to balance, including joint range of motion, spinal flexibility, muscle characteristics and biomechanical communication is different parts of the body (8,10).
Some studies have examined the effect of increasing strength on walking speed, running ability, functional activity, step length, energy storage, etc., which are mentioned below, but so far no study has been found that only examine the effect of trampoline training on muscle strength.
Morton et al. (2005) found that performing progressive resistance training was favorable in children with cerebral palsy. In this study, they strengthened the hamstrings and quadriceps muscles of eight 5-12 year-old children with progressive resistance training (6 sessions per week for 3 weeks) (10). In this study, they concluded that by increasing muscle strength, walking speed, running and jumping skills have also been improved. The results of the above study are consistent with the results of this study.
Eagleton et al. (2004) examined the effect of increasing strength on walking speed, step length, energy storage, as well as the distance covered in 3 minutes. They trained seven patients with cerebral palsy (12-20 years old) for 6 weeks with progressive resistance training that included strengthening the extensors and flexors of the trunk, thighs, knees, ankles, and thigh abductors. The results showed the effectiveness of increased strength on the given factors (11).
Damiano et al. (1998) studied 11 children with cerebral palsy. They concluded that during 6 weeks of strength training, motor function increased with increasing strength of all lower limb muscle groups (12). The results of the above study are consistent with the present study. Also, the results of this study are in line with the results of Hanachi and Kaviani study (2010) that examined the effect of mini-trampoline training on the dynamic balance of elderly women in Tehran during 18 sessions and each session for 30 minutes (13).
Also, the findings of this study are consistent with the results of Hahn and Car (2015); Atilgan (2013) and Sadeghi (2018) studies, which stated that the use of varying levels such as trampoline disturbs the balance, increases the sensory stimulation required between the skin and joints and rises the reactions caused by the stimulation of the body's positioning mechanism.
The results of this study showed that combined training with an emphasis on involving several senses in balance, can be more effective in improving balance than training that consists of just balance, flexibility, aerobics and so on. Multi-sensory training that manipulates the senses involved in balance under stable and unstable reliability levels may also be an effective tool for improving the balance of Down syndrome people. Meanwhile, the use of trampoline due to its low risk nature, as a disturbing balance environment, by providing conditions to challenge the equilibrium system, can be an effective way to improve balance and consequently prevent the falling of Down syndrome patients (14-16).
Conclusion
Based on the findings of the study, the use of trampoline training in the process of physical rehabilitation of patients with Down syndrome is recommended.
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