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Grip and pinch strength in children with Down syndrome
Abstract
Introduction
Children with Down syndrome present with joint laxity, hypotonia and shortened hands resulting in reduced grip and pinch strength. Limited information on grip and pinch strength in children with Down syndrome motivated this study.
Methods
A convenience sample of 30 children with Down syndrome (9–16 years) from special schools and 30 age- and gender-matched healthy school children was studied. Grip and pinch strength were measured according to ASHT standard procedure using JAMAR® dynamometer and B&L pinch gauge. Anthropometric data of upper limb and subject characteristics were recorded.
Results
Children with Down syndrome had significantly lower values for grip, palmar and key pinch strength (p < 0.001) (6.3 kg, 1.91 kg, 2.75 kg) compared to healthy children (15.9 kg, 2.86 kg, 3.52 kg), respectively. A positive moderate correlation was observed between right hand grip strength and body height (r = 0.67), bodyweight (r = 0.69), total arm length (r = 0.68), upper arm length (r = 0.68), forearm length (r = 0.63), hand length (r = 0.68) and hand breadth (r = 0.66) in children with Down syndrome.
Conclusions
Children with Down syndrome presented with 60% less grip strength, 33% less palmar pinch strength and 22% less key pinch strength when compared to children without Down syndrome. Positive moderate correlation was observed between grip strength, body height, body weight and upper limb anthropometric variables in children with Down syndrome.
... Few studies characterize how pinches occur in this group of children. However, though scarce, the literature demonstrates that significantly lower values are found in handgrip strength and hand and critical pinch strength in comparison to typical children (John;Dhanve;Mullerpatan, 2016). In this way, the present study investigates and describes the characteristics of fine motor skills and grip strength of children with DS for handling LEGO ® material and participants' interest in performing the proposed tasks. ...
... Few studies characterize how pinches occur in this group of children. However, though scarce, the literature demonstrates that significantly lower values are found in handgrip strength and hand and critical pinch strength in comparison to typical children (John;Dhanve;Mullerpatan, 2016). In this way, the present study investigates and describes the characteristics of fine motor skills and grip strength of children with DS for handling LEGO ® material and participants' interest in performing the proposed tasks. ...
... Few studies characterize how pinches occur in this group of children. However, though scarce, the literature demonstrates that significantly lower values are found in handgrip strength and hand and critical pinch strength in comparison to typical children (John;Dhanve;Mullerpatan, 2016). In this way, the present study investigates and describes the characteristics of fine motor skills and grip strength of children with DS for handling LEGO ® material and participants' interest in performing the proposed tasks. ...
Introduction:
Down syndrome (DS), first described in 1866 by John Langdon Down, also known as trisomy 21, has specific features, such as delays in motor development and decreased muscle tone. Among the characteristics of DS, the present study highlights the manual function and the skills for handling LEGO® blocks, which involve fine motor coordination, grip strength, and precision for fitting them together.
Objective:
To investigate and describe the characteristics of fine motor skills and grip strength of children with DS for handling LEGO® material and the participants’ interest in performing the proposed tasks.
Method:
The study was cross-sectional, exploratory, and descriptive research. Nineteen children aged between 6 and 12 participated, 9 with DS and 10 without the syndrome. The evaluation of manual pinches (tripod pinch, digital pinch, pluri-digital pinch, handgrip pinch, or strength) occurred in person, with the realization of filming authorized by those guardians. Aspects of interest and attention during the activities were also analyzed. The pinches models used by the groups were the same. Some difficulties of the DSG in the fittings were observed, involving grip strength, visuomotor coordination, and attention.
Conclusion:
The data reinforce the presence of specific challenges for DS children and the need for studies that identify variables that can be configured as facilitators for the handling of the material, such as color identification, visuomotor coordination, attention, communication and the construction of a repertoire on the possible assemblies with LEGO®, to support the therapeutic planning with the use of this material and promote fine motor development, communication, and social interactions, as recommended in the literature.
... Also, weight, height, forearm length, hand length, and breadth were factors that influenced upper extremity strength differences. 26 Hand strength and manual dexterity were similar in both genders; a correlation was also seen between age and hand function. Sound knowledge of manual skills is important for planning various aspects of developmental activities. ...
... Within GenGM 5 min video recording of the infant's mobility was recorded during the period of wakefulness, feeding, supine lying. 26 John et al, 2016 26 Down Syndrome and age-matched typically developed 9-16 y II Cross-sectional study Jamar hydraulic dynamometer, B&L gauge pinch dynamometer, anthropometric measurement of arm using semi-flexible tape ...
... Within GenGM 5 min video recording of the infant's mobility was recorded during the period of wakefulness, feeding, supine lying. 26 John et al, 2016 26 Down Syndrome and age-matched typically developed 9-16 y II Cross-sectional study Jamar hydraulic dynamometer, B&L gauge pinch dynamometer, anthropometric measurement of arm using semi-flexible tape ...
Background
Down Syndrome (DS) is a genetic condition. Physical characteristics like short stature, hypotonia, small, and thick hands result in decreased grip and pinch strength and quality of fine motor tasks.
Purpose
The purpose of this review is to summarize the evidence of upper extremity physical characteristics and its influence on hand function in DS population.
Study Design
A scoping review.
Methodology
A comprehensive electronic literature search was conducted through PubMed, CINAHL, Cochrane Library. The search was limited to articles written in English and published between 2010 to 2021. Additionally, books were referred for a better understanding of the hand function in DS. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR) was adopted to develop the protocol.
Results
Following a detailed review of 28 articles meeting the inclusion criteria, fetuses with a diagnosis of DS are reported to have shortening of humerus on sonographic markers wherein 9% of fetuses had below 5th percentile shortening. Additionally, literature reports that during reaching there was increased trunk rotation (effect size = 0.88). DS population had 60% less grip strength, 33% less palmar pinch strength ,20% less key pinch strength and poor manual dexterity (CI = 4.5-5.5).
Conclusion
Findings of this review concludes that physical characteristics of the upper extremity have an influence on hand function performance in children and adolescents with DS.However, only arm length and hand span have been quantified and correlated with grip strength. Further work must focus on correlation of upper extremity anthropometry and overall hand function in children and adolscents with DS.
... The overall prevalence of the syndrome is one (1) to two (2) in one thousand (1,000) live births, although it may have variability among racial or ethnic groups (Gupta et al., 2011;John et al., 2016;Ijezie, 2023). In the USA. ...
... Muscle weakness is associated with reduced cardiovascular fitness and increased incidence of osteoporosis (Shields et al., 2008). For this reason, the evaluation of the function and muscle strength of the upper limbs is essential for planning the therapeutic program for children and adolescents with trisomy 21 (John et al., 2016). ...
Introduction: Trisomy 21 (Down syndrome) is the most common genetic disorder, which is caused by a chromosomal abnormality and presents various deviations in areas such as mental and motor levels. The presence of extra information corresponding in whole or in part to chromosome 21 affects the development of children with trisomy 21, and abnormal gene expression leads to changes in brain function. The overall prevalence of the syndrome is one (1) to two (2) per thousand (1,000) live births, although the prevalence may have variability among racial or ethnic groups. The purpose of this research is to highlight the deviations in the balance ability, the strength of the upper limbs, and to what extent they affect the quality of life of children and adolescents with trisomy 21. Methods: Eighteen (18) children and adolescents with trisomy 21 participated in the research, with three (3) being excluded due to exclusion criteria. Fifteen (15) children and adolescents with trisomy 21 were finally included, of which four (4) were boys and eleven (11) were girls.
... The muscular strength in persons with DS is affected by various clinical symptoms, including orthopedic, neurological, and cognitive impairments [4]. Children with DS have impaired grip and pinch strength, which are thought to improve with training [5]. Although very limited in number, all studies on grip strength in youngsters with DS report lower force in relation to their peers without intellectual disability [5,6]. ...
... Children with DS have impaired grip and pinch strength, which are thought to improve with training [5]. Although very limited in number, all studies on grip strength in youngsters with DS report lower force in relation to their peers without intellectual disability [5,6]. ...
Background
Down syndrome (DS) is the most frequent genetic mental disability. Individuals with DS experience a variety of physical, motor, and functional challenges throughout the lifespan. However, the inter-relatedness between these domains is relatively unexplored in children with DS. This study aimed to determine which physical and motor characteristics contribute to functional performance in children and adolescents with DS. It also investigated the relationship between physical, motor, and functional domains.
Material/Methods
We enrolled 44 children and adolescents with DS, ages 3–18 years, in this cross-sectional study. The participants were assessed for functional skills (PEDI-CAT), gross motor skills (GMFM-88), balance (PBS), fine motor skills (Nine-hole peg test), grip strength (hand-held Jamar dynamometer), and body mass index (BMI). Descriptive statistics, Pearson’s correlation, and stepwise linear regression were employed for statistical analysis.
Results
Fine motor skills and grip strength were found to be significant predictors of functional performance. All measures, except BMI, were significantly correlated with each other. The participants scored below standard values in all 4 domains of PEDI-CAT, with the social/cognitive skills being most impaired, while mobility proficiency was found to be participants’ strongest asset.
Conclusions
This study demonstrated fine motor skills and grip strength to be predictors of functional performance in children and adolescents with DS. It also showed a high level of inter-relatedness between the variables of physical, motor, and functional domains in this population.
... eleven of the 29 studies were included in the meta-regression analysis, with a total of 656 participants with and without Ds [11,26,27,[38][39][40][41][42][43][44][45]. the random-effects model indicated that the number of reported variables in the hGs protocol was significantly associated with an increase in hGs, with a mean estimate of 20 2). the spline regression analysis revealed an intercept of 13.4231 (se = 6.03, p = 0.03). the slopes for the number of reported variables were: (i) between 6 and 7 variables = 0.6806; (ii) between 7 and 9 variables = 25.2859; ...
Background
Handgrip strength (HGS) serves as a robust predictor of overall strength across various populations, including individuals with Down Syndrome (DS).
Objective
To analyze the HGS measurement protocols used in studies involving individuals with DS.
Methods
Primary sources were sourced from six databases: PubMed, Scopus, Ovid, Embase, ERIC, and Web of Science, spanning from inception to 23rd December 2023. Inclusion criteria focused on individuals with DS, compared with control groups, and examined HGS measurement protocols and outcomes. Meta-regression was utilized to assess bias associated with HGS values concerning different measurement protocols.
Results
Out of 29 studies involving 1816 participants, most controlled for body position (65%), arm position (82%), elbow position (82%), wrist position (62%), handgrip duration (55%), hand adjustment to dynamometer (62%), verbal encouragement (75%), and familiarization (44.8%). The number of reported variables in the HGS protocol was significantly associated with an increase in HGS, with a mean estimate of 20.59 units (SE = 2.59, p < 0.0001, 95% CI [15.49–25.68]), though there was notable heterogeneity (I² = 94.33%). The spline regression analysis showed that the model explained 82.66% of the variation in HGS, with adults having 47.61 units higher HGS than children (p = 0.0009), while obesity was linked to a decrease of 15.68 units (p = 0.0675). Sample size and group had no significant effects.
Conclusion
Overall, protocols for assessing HGS in DS studies are comprehensive yet heterogeneous. Higher HGS values correlated with adherence to standard protocols.
... Al contrastar los datos de prensión manual con los resultados de Tejero-González et al. (2013), se observa que las personas participantes del presente estudio poseen mayor capacidad prensil, tanto con la mano derecha (15,7 ± 6,4 kg) como con la izquierda (14,2 ± 5,7 kg). De igual manera, al comparar con niñez estadunidense, de una edad promedio de 12 ± 3,6 años, esta tiene una menor capacidad de prensión (derecha = 6,3 ± 5,1 kg e izquierda = 5,8 ± 4,9 kg) que la muestra de este estudio (John et al., 2016). Cabe señalar que la población con SD presenta capacidades reducidas en las manos, lo cual está asociado a una desventaja en este tipo test, ya que sus características de hiperlaxitud y miembros superiores más pequeños le provoca una desventaja mecánica, al momento de realizar acciones de prensión y pellizco (Modesto y Greguol, 2019). ...
Introducción:
Aunque existe consenso en cuanto a que la condición física de las personas con síndrome de Down es más baja que la de sus homólogas sin discapacidad, se desconoce el comportamiento específico de esta variable durante el ciclo vital. Objetivo: Determinar el comportamiento de las variables de antropometría y condición física en una población con síndrome de Down, en un lapso de 10 años.
Métodos:
Es un estudio longitudinal comparativo, diseño de panel, realizado con 16 personas (13 hombres y 3 mujeres) con síndrome de Down, entre 10 y 25 años. Las evaluaciones antropométricas y de condición física se realizaron en tres periodos, en los años 2009, 2014 y 2019, mediante masa corporal, talla, perímetro de cintura y cadera y pliegues cutáneos. Además, se calculó el índice de masa corporal, el índice de cintura/cadera y el porcentaje de grasa corporal. Asimismo, se evaluó la fuerza estática de prensión, la prueba de capacidad muscular abdominal, flexibilidad del tronco y capacidad aeróbica.
Resultados:
La antropometría y la condición física presentaron un desarrollo negativo durante los 10 años de monitoreo, lo cual fue el cambio más significativo; hubo aumento del porcentaje de grasa entre el 2009 y 2019 (p = 0,00) y también se encontró una disminución de la capacidad abdominal entre el 2009 y 2019 (p = 0,00).
Conclusiones:
Las personas con síndrome de Down presentan una tendencia decreciente respecto a las variables de condición física y antropometría; además, una evolución negativa, desde el punto de la vista de la salud, considerando un periodo de seguimiento de 10 años.
... Child with DS also suffered from obesity and intellectual disabilities, these factors beside the physical disabilities also contribute to the reduced motor capacity [12]. Amongst the common characteristics of the syndrome, some authors mention small and thick hands, with short fingers and an arched little finger, which could cause some difficulties in manipulative activities [13][14][15]. Reduced hand grip strength in child with DS will contribute to difficulty of the manipulative skills of child's hand and their functional activities [16]. Power of hand grip in child with DS can be measured by hand dynamometer. ...
Background
Children with Down syndrome (DS) are characterized by hypotonia resulting in reduced grip and pinch strength. This study aimed to investigate the influence of shoulder stabilization exercises on hand grip strength in children with Down syndrome. Thirty children with DS assigned randomly into 2 groups each group consists of 15 children. Handheld Dynamometer was used to measure grip strength and different pinch grasps for both groups before and after treatment. Both groups receive the same vocational school activities and the study group receives shoulder stabilization exercises for 3 months.
Results
Results revealed significant increase in the grip strength and different pinch grasps for dominant and non-dominant hands post-treatment in both groups as the main effect of time was statistically significant. Study group showed significant improvement than the control group post-treatment as the main effect of group and time × group interaction effect was statistically significant for dominant and non-dominant hands.
Conclusion
Shoulder stabilization exercises and regular vocational school activities have a positive effect on different grip strength in children with Down syndrome.
Trial registration
PACTR201907896910981 . Registered 5 July 2019. A written consent form was introduced to all participant and signed by their parents.
Down syndrome (DS) is a congenital condition characterized by a third copy of chromosome 21, resulting in a unique phenotype, physical, and intellectual development delays and multisystem health effects. Swimming is a commonly recommended exercise mode for individuals with DS because it has been shown to confer cardiovascular, neuromuscular, and psychological benefits. Local and international organizations offer athletes with DS opportunities to compete in swimming. Swimming athletes with DS benefit from individualized resistance training (RT) delivered by qualified strength and conditioning (S&C) practitioners. The purpose of this article is to provide the S&C practitioner with a needs-driven framework for RT program design with recommendations relevant to potential orthopedic, systemic, and sensorimotor considerations of swimming athletes with DS. Programming and periodization strategies are proposed for maximizing the effectiveness of dry-land RT for this population.
Background
Children with Down syndrome (DS) frequently have concomitant clinical problems. There are no studies in the literature evaluating gross motor development and handgrip strength in the presence of congenital heart disease (CHD), which is one of the most common comorbidities in population with DS. The aim of this study was to compare cardiopulmonary parameters, gross motor development and handgrip strength in children with DS with and without CHD.
Methods
A total of 28 children with DS (14 with CHD and 14 without CHD) were evaluated. Demographic data and cardiopulmonary parameters were recorded. Gross motor development and handgrip strength were assessed.
Results
Children with DS and CHD had lower GMFM‐88 scores and right handgrip strength and higher Wang respiratory score than children with DS and no CHD ( P < 0.05). GMFM‐88 scores were moderately correlated with resting oxygen saturation ( r = 0.46, P = 0.01) and right handgrip strength ( r = 0.67, P < 0.001).
Conclusions
Peripheral muscle strength and oxygen saturation may be factors affecting gross motor development in children with DS. From this point of view, evaluating cardiopulmonary parameters, motor development and handgrip strength in children with DS and CHD is important to identify risks, provide early intervention and support development.
Down syndrome (DS) is a common genetic condition that is associated with a wide range of medical and developmental challenges, including neurological and neurodevelopmental conditions. DS is caused by three copies of chromosome 21 and is the most common genetic cause of intellectual disability (ID). Beyond ID, individuals with DS may also manifest many characteristic medical, neurological, neurobehavioral, and developmental conditions that are complex and result in a variety of clinical presentations with varying etiologies, diagnostic strategies, and interventions. In this clinical review, we present an overview of neurobiology in DS and potential pharmacological targets that may impact the characteristic developmental, cognitive, and learning profile seen in DS. We examine medical conditions that may impact development and functioning as well as neurologic findings such as hypotonia and motor impairments, epilepsy, and abnormal movements. Finally, we extensively discuss the nuances of behavioral, neurodevelopmental, and mental health conditions that may co-occur in children and adolescents with DS and may sometimes be misattributed to manifestations of ID alone. This chapter seeks to draw attention to these conditions that necessitate keen diagnostic discernment, specialized evaluation and treatment, and further research to better inform clinical care.
Deficits in motor performance have been well documented in individuals with Down syndrome (DS). However, only a few studies have focused on manipulative skills and older adults in this population. Given the associations between manipulative skills and daily living activities, more work is needed to examine the aging effect on individuals with DS. A total of 54 adults with DS participated in this study. The results indicated that older participants showed more lateralization than younger participants. They exhibited superior dominant hand preference compared to younger participants. In addition, participants with DS with high verbal ability had better performance in manual dexterity and handgrip force. Therefore, in the clinical setting, assessing mental age may help in identifying individuals with DS at a higher risk of motor impairment. Future work should examine additional determinants with a large sample size to understand the development of manipulative skills in individuals with DS. Furthermore, additional studies are needed to investigate the associations between mental age and other cognitive functions and motor performance in this population.
Currently, there is a major lack of funding for research regarding Down syndrome (DS) cases compared with other conditions. As a result, it is clear that in today’s world, the development expectations of individuals with DS have been underestimated. A common problem in this environment occurs because many children with DS have dexterity issues that make manipulating small objects and grasping a pen particularly difficult. In an attempt to provide DS children with the ability to write longer with no discomfort, our proposed solution is a novel attachable pen grip that quantifies forces applied by the human hand while grasping the pen to write. Initially, data from a comprehensive questionnaire was collected on grip styles, writing speed, and how many words are written. Several other research methodologies were used, such as surveys, observations and interviews. Participants included experts, specialists, individuals with DS and families of children with DS. In executing this work, we gained a better understanding of the difficulties the child is facing and we were able to refine the design to best accommodate their needs. The market gap and limited writing tools for children with DS motivated this study to create the suitable product to reduce cramping, improve handwriting practice and to fulfil the physical and emotional need for children with DS. The overall potential benefit of the envisioned product is to improve the quality of life for these children and ease the minds of their caregivers.
Introduction
Down syndrome (DS) is a genetic disorder characterized by the presence of an extra chromosome, which is typically associated with motor and cognitive changes that interfere with the ability to perform daily activities. To enable gains in motor skills in individuals with DS, one option is to use new technologies such as mobile phone tasks in a virtual reality environment.
Objective
To explore whether a mobile phone game is a feasible tool to improve motor performance of upper limbs in individuals with DS.
Method
The game Marble Maze Classic® was used, in which the participants moved the mobile phone to guide a virtual marble through a maze design. We evaluated 100 individuals, 50 with DS and 50 individuals with typical development matched by gender and age. The participants were divided into two conditions: a ‘condition with an original maze’, with 25 individuals in the comparison group (typical development) and 25 in the experimental group (DS) and a ‘reverse condition’ with the same number of participants that used a maze design with an opposite path to the original as a counter-balance measure. The dependent variable used was time in seconds to finish the maze path. ANOVA was used in analysis of group differences. Post-hoc comparisons were performed using Tukey’s Honest Significant Difference test (p < 0.05).
Results
The comparison group improved during practice and maintained performance in the retention phase; they were able to transfer learning to different mazes. The DS group improved and retained motor performance, but transferred motor performance only in the original maze, not in the reverse condition. That is, the DS group failed to transfer learning as effectively as the comparison group.
Conclusion
People with DS managed to adapt to the task but underperformed compared to people with TD. Difficulty in maintaining performance with increased task difficulty was observed in the DS participants, highlighting the need to differentiate such tasks in improving performance.
Abstract:
Purpose: In this study, it has been aimed to determine the effect of 8-week ballhandling traning program on upper-lower extremity muscular strength of individuals with down syndrome.
Method: In the study, twenty one individuals who had been medically diagnosed with trisomy down syndrome and still attending special education and rehabilitation centers have participated as voluntarily. The participants have been selected randomly and divided into exercise (10 participants) and control groups (11 participants). The exercise group was trained with Ballhandling Training Program for 8 weeks; 2 days a week and a 60 minute per day. However, the control group did not participate in any activities regularly. In the study, Takei hand grip dynamometer was used to measure upper extremity strength. For the measurement of lower extremity strength, standing broad jump–vertical jump, wall squat test and takei leg dynamometer strength tests were utilized. The statistical analyses of the data were realized by using SPSS 21 package program.
Results: The means of after eight weeks, leg strenght test (pre:22,47±13,12; post:30,90±13,87; p=,005) wall squat test (pre:23,55±10,95; post:30,92±13,87; p=,005) and dominant hand grip strenght (pre:11,35±5,74; post:14,55±7,18; p=,024) were found more significant than the means of baseline in exercise group. But, It was not significant differences between post measurements of exercise and control groups (p>0.05).
Conclusion:The findings of the study have revealed that 8-week ballhandling training program made a positive effect on upper-lower extremity strength of individuals with down syndrome. However, it is assumed that if the program implemented is maintained for a longer period of time, the positive effect of the training on individuals with DS will increase.
The intra-and inter-tester reliability for measurement of handgrip strength and indexgrip strength using the Jamar dynamometer was investigated in 32 healthy volunteers, and the intra-tester reliability in 13 patients with cervical radiculopathy. The results from the reliability studies showed that handgrip and indexgrip strength measured with the Jamar dynamometer is a reliable method (ICC values 0.85–0.98) and can be recommended for use in clinical practice. Age-and sex-specii c reference values for handgrip strength and indexgrip strength were measured with the Jamar dynamometer in 101 randomly selected healthy volunteers, aged 25–64 years. The results from the reference value study showed that sex is a more important determinant of hand strength than age, height and body weight. The reference values for hand strength improve the potential for objective evaluation of patients with arm/hand disorders caused by cervical radiculopathy.
Niños con Síndrome de Down (SD) presentan atraso en la adquisición de habilidades motoras con relación aquellos con desarrollo normal, lo que puede interferir en actividades como la fuerza de prensión y la destreza manual. La evaluación de esas tareas puede fornecer indicadores de desempeño en las actividades diarias. El objetivo de este estudio fue analizar la correlación entre fuerza de prensión y destreza manual de niños con SD y de los saludables con edades entre siete y nueve años. Veinte seis niños con SD, de ambos los géneros, fueron los participantes, constituyendo el Grupo SD y 30 niños saludables compusieran el Grupo Control (GC). La evaluación de la fuerza de prensión fue realizada con el dinamómetro Jamar y en la destreza manual se utilizó el Test de Caja y Bloques. El Grupo SD presentó desempeño inferior tanto en la fuerza de prensión cuanto en la destreza manual, cuando fue comparado al GC. No hubo correlación significativa entre la fuerza de prensión y la destreza manual en el Grupo SD. En el GC, esa correlación existió y no hubo diferencia de desempeño entre los géneros para los ítems evaluados. Lo desempeño en los testes de fuerza de prensión y destreza manual en el GC mostró una evolución con el decurso de la edad; pero en el Grupo SD eso no ocurrió. Se concluyó que fueron encontradas diferencias en el desempeño de los dos grupos, lo que indica características peculiares para la SD. Esos dados deben ser mas investigados ya que pueden contribuir a la identificación de objetivos que van a ser considerados en programas de estimulación.
Children (5–12 years) and adolescents (13–19 years) with Down syndrome (DS) possess a set of health, anatomical, physiological, cognitive, and psycho-social attributes predisposing them to limitations on their physical fitness and physical activity (PA) capacities. The paucity of studies and their conflicting findings prevent a clear understanding and/or substantiation of these limitations. The purpose of this article was to review the measurement, determinants and promotion of physical fitness and PA for youth (i.e., children and adolescents) with DS. The existing body of research indicates that youth with DS: 1) have low cardiovascular and muscular fitness/exercise capacity; 2) demonstrate a greater prevalence of overweight and obesity; 3) a large proportion do not meet the recommended amount of daily aerobic activity; and 4) their PA likely declines through childhood and into adolescence. Future research should focus on: 1) strength testing and training protocols; 2) methodologies to determine PA levels; and 3) practical interventions to increase PA.
The North West Adelaide Health Study is a representative longitudinal cohort study of people originally aged 18 years and over. The aim of this study was to describe normative data for hand grip strength in a community-based Australian population. Secondary aims were to investigate the relationship between body mass index (BMI) and hand grip strength, and to compare Australian data with international hand grip strength norms.
The sample was randomly selected and recruited by telephone interview. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions.
Following the exclusion of 435 participants who had hand pain and/or arthritis, 1366 men and 1312 women participants provided hand grip strength measurement. The study population was relatively young, with 41.5% under 40 years; and their mean BMI was 28.1 kg/m2 (SD 5.5). Higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages. Australian norms from this sample had amongst the lowest of the hand grip strength of the internationally published norms, except those from underweight populations.
This population demonstrated higher BMI and lower grip strength in younger participants than much of the international published, population data. A complete exploration of the relationship between BMI and hand grip strength was not fully explored as there were very few participants with BMI in the underweight range. The age and gender grip strength values are lower in younger adults than those reported in international literature.
Down syndrome (DS) is a genetic disorder resulting from trisomy 21 that causes cognitive impairment, low muscle tone and craniofacial alterations. Morphometric studies of the craniofacial and appendicular skeleton in individuals with DS suggest that bone development and homeostasis are affected by trisomy. The Ts65Dn mouse model has three copies of approximately half the genes found on human chromosome 21 and exhibits craniofacial skeletal and size differences similar to those observed in humans with DS. We hypothesized that Ts65Dn and euploid mice have distinct differences in bone development and homeostasis influencing both the craniofacial and appendicular skeletal phenotypes. Quantitative assessment of structural and mechanical properties of the femur in Ts65Dn and control mice at 6 and 16 weeks of age revealed significant deficiencies in trabecular and cortical bone architecture, bone mineral density, bone formation, and bone strength in trisomic bone. Furthermore, bone mineral density and dynamic dentin formation rate of the skull and incisor, respectively, were also reduced in Ts65Dn mice, demonstrating that trisomy significantly affects both the craniofacial and appendicular skeleton.
Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the predictive power of cofactors and to predict population-based normative grip and pinch strength.
A representative population survey was used as the basis for prediction analyses (n = 978). Bivariate relationships between grip/pinch strengths of the dominate hand were explored by means of all relevant mathematical functions to maximize prediction. The resulting best functions were combined into a multivariate regression.
Polynoms (up to the third degree) were the best predictive functions. On the bivariate level, height was best correlated to grip (46.2% explained variance) and pinch strength (37.7% explained variance) in a linear relationship, followed by sex, age, weight, and occupational demand on the hand. Multivariate regression provided predicted values close to the empirical ones explaining 76.6% of the variance for grip strength and 67.7% for pinch strength.
The five easy-to-measure cofactors sex, age, body height, categorized occupational demand on the hand, and body weight provide a highly accurate prediction of normative grip and pinch strength.
The purpose of the present study was to investigate the trend of handgrip strength and to assess the normative values of this trait in randomly selected 747 unrelated, normal, healthy Indian males (325 right hand and 92 left hand dominant) and females (297 right hand and 33 left hand dominant) aged 6 - 25 years from different schools and Guru Nanak Dev University, Amritsar, Punjab, India. Three anthropometric measurements, viz. height, weight and BMI were carried out with standard techniques. Handgrip strength was measured using a standard adjustable digital handgrip dynamometer (Takei Scientific Instruments Co. LTD, Japan) at standing position with shoulder adducted and neutrally rotated and elbow in full extension. The findings of the present study indicated a gradual increment of both right and left handgrip strength from 6 to 23 years in males and from 6 to age 21 years in females. Statistically highly significant sex differences (p<0.001) were found in right dominant (t = 12.84) and non-dominant (t = 13.46) handgrip strength, where males had higher mean values in all the anthropometric variables than females.
The present study is based on the association of left and right hand grip strength with eight anthropometric traits, viz. height, weight, body mass index, hand length, hand breadth, upper arm length, forearm length and total arm length in 100 male cricketers aged 17 - 21 years (mean age 18.29 ± 2.21 years ) of Amritsar, Punjab, India. A total of 100 controls were also taken for comparisons. The findings of the present study indicate a strong association of right hand grip strength with height (r =0.383), weight (r=0.498), body mass index (r=0.401), hand length (r=0.444), hand breadth (r=0.326) and forearm length (r=0.215). Whereas left hand grip strength was reported to be closely associated with height (r=0.355), weight (r=0.472), body mass index (r=0.374), hand length (r=0.320) and hand breadth (r=0.330). Internet Scientific Publications, LLC., 1996 to 2009.
Introduction
Normative values of grip and pinch strength are used to determine the effect of treatment, to assess patients’ initial limitation and provide a baseline for re-assessment of patient progress. Data gathered from western populations cannot be used for reference in Indian populations due to variations in genetic, environmental and nutritional factors.
Methods
A convenience sample of 1005 healthy adults was recruited for this descriptive study. Grip and pinch strength were measured with elbow positioned at 0°, 45°, 90° and full elbow flexion using a JAMAR dynamometer and B&L Pinch gauge.
Results
Men presented significantly higher values for grip strength ( p ≤ 0.001) at 0° of elbow flexion (37.8 kg) than women (22.12 kg). For remaining positions of the elbow, average grip strength values in men were 33 kg and in women were 20 kg. Men presented significantly higher values of tip, palmar and key pinch (3.9, 6.7 and 7.2 kg) than women (3.2, 4.71 and 4.81 kg). Grip strength was significantly different at different positions of the elbow ( p ≤ 0.001); it was highest at 0° and lowest at 135° of elbow flexion among men.
Conclusions
Findings from study will provide reference values for grip, tip, palmar and key pinch strength for healthy Indian adults. Grip and pinch strength of healthy Indian adults is less compared with age and gender-matched population from other continents.
The purpose of this study was to investigate the effects of a proposed strength and agility training program of adolescents with Down syndrome. Ninety-two adolescents were recruited and evenly randomized to two intervention groups (exercise group vs. control group). The mean age for the exercise and the control group was 10.6±3.2 and 11.2±3.5 respectively. The exercise training program consisted of a 5-min treadmill exercise and one 20-min virtual-reality based activity administered three times a week for 6 weeks. Pre- and post-test measures were taken for muscle strength and agility performance. The measured muscle included hip extensor, hip flexor, knee extensor, knee flexors, hip abductors, and ankle plantarflexor. A handheld dynamometer was used to measure the lower extremities muscle strength, and agility performance was assessed by the strength and agility subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition. The exercise group had significant improvements in agility (p=0.02, d=0.80) and muscle strength of all muscle group (all p's<0.05, d=0.51-0.89) assessed in comparison to the control group after the 6-week intervention. Knee muscle groups including both flexors and extensors had the greatest gains among all the muscles measured. A short-term exercise training program used in this study is capable of improving muscle strength and agility performance of adolescents with DS.
This Clinical Report was revised. See https://doi.org/10.1542/peds.2022-057010
These guidelines are designed to assist the pediatrician in caring for the child in whom a diagnosis of Down syndrome has been confirmed by chromosome analysis. Although a pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given a prenatal diagnosis of Down syndrome will be referred for review of the condition and the genetic counseling provided. Therefore, this report offers guidance for this situation as well.
Children with trisomy 21 display atypical manual skills that change to some extent during development. We examined grasp characteristics and their development in 35 children with trisomy 21, aged 4-18 years, who performed simple manual tasks (two manual tasks of the Movement Assessment Battery for Children, and grasping of five wooden blocks whose size was determined by their hand size). The age-matched comparison group included 35 typically developing children. Children with trisomy 21 were found to use fewer fingers than children in the comparison group in each task. They also used specific grasps and tended to extend fingers that were not involved in the grip. While some specific grasp characteristics of children with trisomy 21 decreased with age, other did not, and remained present throughout development. The perceptual-motor development of children with trisomy 21 should be analyzed in terms of atypical development rather than developmental delay.
The aim of this study was to investigate the age-related changes in hand grip strength (both right and left hand) among rural and urban Jat females and its correlation with various anthropometric variables. The present cross-sectional study was based on a sample of 600 Jat females (rural=300, urban=300), ranging in age from 40 to 70 years. Findings indicated that rural and urban Jat females exhibit an age-related decline in the mean values of hand grip strength (both right and left hand). The comparison suggested that rural Jat females had significantly higher overall mean value of hand grip strength (kg) (right hand=20.35 vs 18.87, p<0.001 and left hand=17.05 vs 15.68, p<0.001) than their urban counterparts. Mean values for right hand grip strength were found to be higher than left hand grip strength in rural as well as urban Jat females. Significant and positive correlation coefficients exist between hand grip strength (both right and left hand) and various anthropometric variables (height, weight, body mass index, biceps and triceps skinfold thickness) in both rural and urban Jat females. An age-related decline in manual functioning of rural and urban Jat females may be attributed to behavioral factors (reduced physical activity, sedentary lifestyle) and poor nutrition (deteriorating quality and quantity of food intake with increasing age) associated with the normal aging process.
Very few studies have evaluated the association of articular hypermobility and radiographic osteoarthritis (OA) in humans. We assessed hypermobility and its relationship to radiographic hand OA in a family-based study.
A total of 1,043 individuals were enrolled in the multicenter Genetics of Generalized Osteoarthritis study, in which families were required to have 2 siblings with radiographic OA involving >/=3 joints (distributed bilaterally) of the distal interphalangeal (DIP), proximal interphalangeal (PIP), or carpometacarpal (CMC) joint groups, and OA in at least one DIP joint. Radiographic OA was defined as a score of >/=2 on the Kellgren/Lawrence scale in one or more joints within the group. The Beighton criteria for assessment of hypermobility were recorded on a 0-9-point scale. Hypermobility was defined as a Beighton score of >/=4, a threshold generally used to establish a clinical diagnosis of joint laxity. A threshold of >/=2 was also evaluated to assess lesser degrees of hypermobility. The Beighton score for the present was calculated based on clinical examination, and that for the past was based on recall of childhood hypermobility in the first 2 decades of life. The association of hypermobility and radiographic OA of the PIP, CMC, and metacarpophalangeal joints was evaluated in all participants and in men and women separately. Multiple logistic regression was used to examine the relationship of hypermobility with radiographic OA in each joint group, after adjusting for age and sex. The association of hypermobility and DIP OA was not evaluated, because evidence of DIP OA was required for study inclusion.
Using a threshold Beighton score of 4, 3.7% of individuals were classified as hypermobile based on the present examination, and 7.4% were classified as hypermobile based on the past assessment. A significant negative association between present hypermobility and age was observed. In persons with hypermobility, the odds of OA in PIP joints was lower (for present, odds ratio [OR] 0.34, 95% confidence interval [95% CI] 0.16-0.71; for past, OR 0.43, 95% CI 0.24-0.78). Similar results were obtained using a threshold Beighton score of 2. The lower odds of PIP OA with hypermobility were significant after adjusting for sex and age (for present, OR 0.44, 95% CI 0.20-0.94; for past, OR 0.48, 95% CI 0.26-0.87).
This study demonstrated a joint-protective effect of hypermobility for radiographic OA of PIP joints. In contrast to previous studies showing an association of hypermobility and CMC OA, in this cohort there was no evidence for increased odds of OA in any joint group of the hand in association with articular hypermobility.
To determine the effects of a home exercise program of combined aerobic and strength training on fitness with a 10.5-year-old girl with Down syndrome (DS). Measurements included cardiovascular variables, strength, body composition, flexibility, and skill.
The subject participated in a home exercise program: 30 to 60 minutes of moderate- to high-intensity exercise five to six days per week for six weeks. The cardiovascular variables monitored were heart rate, respiration rate, and oxygen consumption during a submaximal treadmill stress test. Other measures included 10-repetition maximal strength of selected muscle groups, body mass index, flexibility, Gross Motor Scales of the Bruininks-Oseretsky Test of Motor Proficiency, and anaerobic muscle power.
Improvements in submaximal heart and respiration rates, aerobic performance, muscle strength and endurance, gross motor skills, and anaerobic power were observed for this subject. Body weight and flexibility were unchanged.
For this subject, a combined aerobic and strength-training program resulted in improved cardiopulmonary functions not observed in previous studies of subjects with DS.
Anthropometry: a laboratory manual on biological anthropology
- I P Singh