Middle Eastern Journal of Disability Studies

fa بررسی راهبردهای جبرانی کنترل قامت در کودکان با سندرم داون در شرایط مختلف حسی Study of Compensatory Postural Control Strategies in Children with Down Syndrome in Different Sensory Conditions توانبخشی Rehabilitation مقاله پژوهشی اصیل Original Research Article چکیده زمینه و هدف: باتوجه به تفاوت‌های کودکان با سندرم داون در فعالیت‌های تعادلی و تأخیر آن‌ها در توسعهٔ مهارت‌های تعادلی و دیگر مهارت‌های وابسته به تعادل، به‌نظر می‌رسد آن‌ها از راهبردهای جبرانی متفاوتی برای حفظ تعادل خود استفاده می‌کنند؛ ازاین‌رو هدف از مطالعهٔ حاضر بررسی راهبردهای جبرانی کنترل قامت در کودکان با سندرم داون بود. روش‌بررسی: تحقیق حاضر از نوع علّی-مقایسه‌ای بود. حجم نمونه را ۱۴ کودک با سندرم داون با دامنهٔ سنی ۶تا۱۱ سال تشکیل دادند که تحت پوشش مرکز توان‌بخشی قائم بخش احمدآباد شهرستان اسلامشهر در سال ۹۸-۱۳۹۷ بودند و همچنین با ۱۴ کودک سالم از لحاظ سنی همسان‌سازی شدند که به‌صورت هدف‌مند و دردسترس در این تحقیق شرکت کردند. راهبردهای جبرانی کودکان با سندرم داون با استفاده از دستگاه پوسچروگرافی پویای کامپیوتری و در شش شرایط مختلف حسی ارزیابی شد. داده‌ها با استفاده از آزمون تحلیل واریانس چندمتغیره (مانوا) و آزمون تعقیبی توکی در نرم‌افزار SPSS نسخۀ ۲۵ در سطح معناداری ۰٫۰۵ تحلیل شد. یافته‌ها: حذف اطلاعات سیستم بینایی و متحرک‌بودن محیط بینایی به‌طوری‌که منجربه ارائهٔ آرایه‌های نادرست بینایی شود، منجربه تفاوت معناداری بین دو گروه در اتخاذ راهبرد جبرانی کنترل قامت شد (۰٫۰۰۱=p)؛ به‌صورتی‌که گروه عادی از راهبرد مچ و گروه سندرم داون از راهبرد لگن بهره برد؛ همچنین در وضعیت متحرک‌بودن سکوهای نیرو که منجربه دستکاری اطلاعات حس عمقی ‌شد، گروه کودکان با سندرم داون از راهبرد لگن استفاده کرد؛ ولی کودکان با سندرم داون اقدام به گام‌برداشتن کردند (۰٫۰۰۱=p). نتیجه‌گیری: براساس یافته‌های این پژوهش، هنگام حذف یک ‌سیستم حسی به‌ویژه حس بینایی، کودکان با سندرم داون درمقایسه با کودکان سالم راهبرد‌های محتاطانه‌تری را اتخاذ می‌کنند. Abstract Background & Objectives: One of the major early symptoms seen in almost all children with Down syndrome is learning disabilities and developmental delays. Postural control studies using force plates in people with Down syndrome have revealed more information about the differences between these children and normal peers. Given the differences in children with Down syndrome in balance and their delays in developing balance–related skills, they seem to use different compensatory strategies to maintain their balance. Therefore, the present study aimed to determine compensatory postural control strategies in children with Down Syndrome in different sensory situations. Methods: The present study was a causal–comparative study. This study investigated compensatory postural control strategies of children with Down syndrome in different sensory conditions. The sample size for the present study was determined by G*Power software to be 16, which was reduced to 14 due to the absence of 2 subjects. Therefore, the sample size in this study was 14 children with Down syndrome aged 6 to 11 years. They were under the supervision of Ahmadabad Ghaem Rehabilitation Center in Eslamshahr City, Iran, in the academic year 2018–2019. Also, 13 healthy children of the same age from primary schools in Eslamshahr City were included as the control group. The inclusion criteria were children with Down syndrome, with normal vision, no history of fractures and deformities in the lower extremities, and non–athletes. The range of IQs acceptable for children with Down syndrome was 60 to 85. Any participant who was unable to continue the study was excluded from the study. The sensory organization test assesses the performance of the proprioceptive and vestibular visual senses in postural control. The test has 6 different sensory states. According to the defined protocol, each test is performed 3 times. The average indicates the postural control strategy (0 to 100), with 0 representing the hip and 1 for the ankle strategies. The force plate is fixed in the first three positions and moves in the anterior and posterior directions in the other three states. People with bare feet stood on the machine, each attempt lasting 20 seconds with equal rest intervals of 5 minutes between the three defined attempts on the device. Descriptive statistics indices, including frequency, mean, standard deviation, and inferential statistics, including multivariate analysis of variance (MANOVA) and Tukey's post hoc test, were calculated using SPSS 25 at a significant level of 0.05. Results: The results showed no significant difference between the two groups in the first situation, where all the sensory information was available (p=0.543). Both groups used the ankle strategy. In the second condition, with the deletion of the visual sensory input, and the third condition, with eyes open but the visual environment moving to result in false visual arrays, a significant difference was observed between the two groups (p=0.001). The normal group used the ankle strategy, and the Down syndrome group used the hip strategy. In the fourth situation, where the force plate was mobile and resulted in the manipulation of proprioception information, there was a significant difference between the two groups in the stance control compensatory strategy (p=0.001), and both groups used the hip strategy. There was no significant difference between the two groups in the fifth condition when eyes closed, and the mobile force plate eliminated the proprioceptive but kept the vestibular information (p=0.606). In the sixth situation, where proprioceptive information was removed, and the person was given inappropriate visual information to evaluate vestibular information, there was no significant difference between the two groups (p=0.671). In this situation, both groups used the step strategy. Conclusion: Based on the findings of this research, when removing a sensory system, especially the sense of vision, children with Down syndrome adopt more cautious strategies compared to healthy children. کودکان با سندرم داون, راهبرد جبرانی کنترل قامت, تعادل, شرایط مختلف حسی Children with Down syndrome, Compensatory postural control strategy, Balance, Different sensory conditions 251 251 http://jdisabilstud.org/browse.php?a_code=A-10-1552-1&slc_lang=fa&sid=1 Javad Parhizkar Kohneh Oghaz جواد پرهیزکار کهنه اوغاز parhizkarjavad@yahoo.com 100319475328460054908 100319475328460054908 No PhD Student in Motor Development, Science and Research Branch, Islamic Azad University, Tehran, Iran دانشجوی دکتری رشد حرکتی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران Ahmad Reza Movahedi احمدرضا موحدی armovahedi@yahoo.com 100319475328460054909 100319475328460054909 Yes Professor of Motor Behavior Group, University of Isfahan, Isfahan, Iran استاد گروه رفتار حرکتی دانشگاه اصفهان، اصفهان، ایران Afkham Daneshvar افخم دانشفر afkham.danesh@gmail.com 100319475328460054910 100319475328460054910 No Associate Professor of Motor Behavior Group, Alzahra University, Tehran, Iran دانشیار گروه رفتار حرکتی دانشگاه الزهرا، تهران، ایران؛ Abdollah Ghasemi عبدالله قاسمی a_gh_m2003@yahoo.com 100319475328460054911 100319475328460054911 No Assistant Professor of Motor Behavior Group, Science and Research Branch, Islamic Azad University, Tehran, Iran استادیار گروه رفتار حرکتی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران