Article Summary-Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial- Asakhawi 2019
Purpose: This study was conducted to research the effects of core stability interventions versus treadmill training on dynamic balance in children with Down syndrome. Children with Down syndrome have difficulty maintaining posture and have an abnormal gait pattern, therefore, increasing their risk of falls. There has not been much research on this topic but the research that has been done concludes that core stabilization training in children with Down syndrome can improve static balance and reduce the risk of falls, while treadmill training strengthens the lower extremities, improving the gait pattern and decreasing fall risk. This study was a randomized control trial.
Population: There were 45 children with Down syndrome total in this study with ages ranging from 4-6 years old. All of the subjects came from a specific clinic in Egypt. Exclusion criteria included children with any neurological, musculoskeletal, or mobility disorders, cardiac abnormalities, and vision or hearing loss. Children must have been able to walk and stand independently without falling repeatedly and recognize and understand commands given to be included in the study.
Outcome Measures: Initial assessments were done using the Berg Balance test and the Biodex Balance System. The Berg tests functional balance and the BBS assesses neuromuscular control and dynamic postural stability.
Methods/Intevrentions: The 45 children were randomly placed in 3 groups. Group A was the control group and they received a traditional exercise program to increase postural control and balance for 60 minutes. Group B was given that same traditional plan for 30 minutes, as well, as a treadmill training plan. They ambulated on the treadmill at 75% speed for 20 minutes, 3 times per week for 8 weeks total. The children in group B did a 5 minute stretching warm up, followed by 20 rounds of 15 seconds with 2 hand support, 15 seconds with 1 hand support, and 30 seconds of no upper extremity support. A 5 minute cool down concluded the session. Group C was given the same traditional exercise plan for 30 minutes along with core stability training. There were 3 30 minute sessions per week for 8 weeks. The exercises utilized Swiss balls and limb movement in three phases: fixed position with isometric contractions, unbalanced position to a balanced position with isometric contractions, and dynamic movements using the child’s weight.
Results:There were no significant differences in balance or stability between the three groups prior to treatment. Group B and C had significantly improved in functional balance and overall stability compared to group A, however, there was no significant difference between group B and C.
Conclusion: Overall, this study found that treadmill training and core stability do improve balance of children with Down syndrome but that one is not better than the other.
Strengths/Limitations: There are a few limitations to this study including the small sample size used, the subjects coming from one distinct clinic in one geographic location, and it is unknown whether the effects from these trainings are held long term due to the post measures being done immediately after treatment is completed with no follow up. A strength of this study is that the research that is out there, although minimal, does support the findings. Another strength is that either of these modalities in conjunction with a traditional therapy program can be used to increase balance in children with Down syndrome. This gives the PT more room for creativity in personalizing a training program to improve balance and postural stability within this population.
4 responses to “Article Summary-Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial- Asakhawi 2019”
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Interesting article, I would like to see if the treadmill training v. core stability exercises alone without the traditional exercise plan would yield different results or would they remain the same? Maybe the traditional exercise program helped even the gap between the treadmill training v. the core stability exercises and without it one might have been better than the other?
That is a great idea! I would love to see a study with those groups and see what the differences are.
Great summary. Though there were limitations, it will be great to take this information into the clinic when I work with pediatrics and specifically if I get to work with children with down syndrome. Balance is such an important factor for many functional activities so knowing how to implement the best intervention is super valuable, thanks for highlighting these interventions.
Hi Bry,
Nice job! After reading your summary, I would definitely like to see a similar study done with a larger sample size as well as participants from various places to determine whether treadmill training or core stability or both improve balance in those children with Down syndrome. Although, I completely agree with you that a traditional therapy program along with either modality allows for the therapist to really customize their intervention for a patient with Down syndrome and to ultimately help them to improve their balance.