Postural and gait performance in children with attention deficit/hyperactivity disorder

ArticleinGait & posture 29(2):249-54 · November 2008with41 Reads
DOI: 10.1016/j.gaitpost.2008.08.016 · Source: PubMed
Up to 50% of children and adolescents with attention deficit/hyperactivity disorder (ADHD) exhibit motor abnormalities including altered balance. Results from brain imaging studies indicate that these balance deficits could be of cerebellar origin as ADHD children may show atrophy in those regions of the cerebellum associated with gait and balance control. To address this question, this study investigated postural and gait abilities in ADHD children and compared their static and dynamic balance with children with known lesions in the cerebellum. Children diagnosed with ADHD according to DSM IV-TR diagnostic criteria were compared with children with chronic surgical cerebellar lesions and age-matched controls. A movement coordination test was used to assess differences in motor development. Postural and gait abilities were assessed using posturography, treadmill walking and a paced stepping task. Volumes of the cerebellum and the cerebrum were assessed on the basis of 3D magnetic resonance images (MRI). Children with cerebellar lesions showed significant performance decrements in all tasks compared with the controls, particularly in the movement coordination test and paced stepping task. During dynamic posturography ADHD-participants showed mild balance problems which correlated with findings in cerebellar children. ADHD children showed abnormalities in a backward walking task and minor abnormalities in the paced stepping test. They did not differ in treadmill walking from the controls. These findings support the notion that cerebellar dysfunction may contribute to the postural deficits seen in ADHD children. However, the observed abnormalities were minor. It needs to be examined whether balance problems become more pronounced in ADHD children exhibiting more prominent signs of clumsiness.
    • "Indeed, motor hyperactivity is a prominent feature of ADHD, manifested by agitation, restlessness and unnecessary body movements (Zametkin & Ernst, 1999). Various motor difficulties have been identified in individuals with ADHD, such as gross motor skill difficulties (e.g., ball skills) (Piek, Pitcher, & Hay, 1999), fine motor difficulties (e.g., manual dexterity and bimanual coordination tasks) (Piek et al., 1999; Rommelse et al., 2007), balance (Mao, Kuo, Yang, & Su, 2014), and gait and postural control problems (Buderath et al., 2009; Papadopoulos, McGinley, Bradshaw, & Rinehart, 2014). In addition, children with ADHD have demonstrated a delay in their overall motor development when compared to controls (Goulardins et al., 2013; Poeta & Rosa-Neto, 2007; Vidarte, Ezquerro, & Giraldez, 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Research has suggested an important association between motor proficiency and overweight/obesity. Many children with motor difficulties experience ADHD symptoms which have also been linked with overweight/obesity. Previous research has not considered both ADHD and motor performance when investigating their relationship with overweight/obesity. Aims: To investigate the relationships between motor performance, ADHD symptoms, and overweight/obesity in children. Methods and procedures: A cross-sectional study was conducted involving189 children aged six to 10 years. Symptoms of ADHD were identified using the SNAP-IV rating scale. Motor impairment (MI) was identified using the Movement Battery Assessment for Children-2. Body composition was estimated from the Body Mass Index (BMI) based on World Health Organization child growth standards. Outcomes and results: Balance was the only motor skill associated with BMI even after controlling for gender and ADHD. Group comparisons revealed that the proportion of overweight ADHD children was significantly less than the proportion of overweight control children and overweight MI children; the proportion of underweight ADHD children was significantly greater than the proportion of underweight MI children. Conclusions and implications: The results highlight the importance of taking into consideration both ADHD symptoms and motor difficulties in the assessment and intervention of physical health outcomes in children with ADHD and/or movement problems.
    Full-text · Article · May 2016
    • "After MPH treatment, children with ADHD showed significantly reduced stride-time variability, suggesting that MPH could improve the function of dopaminergic networks, thus improving rhythmicity, attention, and motor control in children with ADHD. Buderath et al. (2009) also reported minor improvements in motor control in children with ADHD after MPH treatment. Polishook et al. (2009) explored postural stability under single-and dual-task conditions (while performing a memoryattention demanding task such as memorizing children's songs while listening to music) in children with ADHD after MPH treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: HIGHLIGHTS Both spatial and temporal analyses of the Center of Pressure demonstrate that children with ADHD have poorer postural control than typically developing sex-, age-, and IQ-matched children. Poor sensory integration in postural control could partially explained the deficits in postural stability in children with ADHD. MPH treatment improves postural performance in both spatial and temporal domains in children with ADHD. MPH improves postural control specifically when visual and proprioceptive inputs are misleading. Such improvement could be due to MPH effects on neurons, facilitating cerebellar processing of postural control. The aim of this study was to examine postural control in children with ADHD and explore the effect of methylphenidate (MPH), using spatial and temporal analyses of the center of pressure (CoP). Thirty-eight children with ADHD (mean age 9.82 ± 0.37 years) and 38 sex- age- and IQ-matched children with typically development were examined. Postural stability was evaluated using the Multitest Equilibre machine (Framiral®) at inclusion and after 1 month of MPH in children with ADHD. Postural stability was assessed by recording under several conditions: with eyes open and fixed on a target, with eyes closed and with vision perturbed by optokinetic stimulation, on stable and unstable platforms. At inclusion, we observed poor spatial and temporal postural stability in children with ADHD. The spectral power index was higher in children with ADHD than in controls. Canceling time was shorter at low and medium frequencies of oscillation and longer at higher frequencies in children with ADHD. After 1 month of MPH, the surface area and mean velocity of the CoP decreased significantly under the most complex conditions (unstable platform in the absence of proprioceptive and visual inputs). The spectral power index decreased significantly after MPH while the canceling time did not change. Poor postural control in children with ADHD supports the hypothesis of cerebellar dysfunction in this disorder. Postural control could be improved by a more efficient processing of sensory inputs (a high-level process), as suggested by the decrease in spectral power index after MPH without changes in the canceling time (a low-level process).
    Full-text · Article · May 2016
    • "This ability depends on the perfect interaction of the musculoskeletal, motor and sensory nervous systems [13,23]. Sensory integration tests with a force plate have been widely used to quantify changes in balance (e.g. in children with chronic low back pain [24] , women with stress incon- tinence [25] , children with attention deficit and hyperactivity disorders (ADHD) [26], and children with hemophilia [27,28] ). Despite the variations among studies, the 'common pathway' for assessing balance is either via the deprivation of visual information (i.e. the eyes-closed condition) or by making the information from the receptors in the feet inaccurate (i.e. by standing on a foam surface) or by combining these strategies, as was done in the current study. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE. Material and methods: A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion. Results: The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG. Conclusions: Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.
    Full-text · Article · May 2016
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