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Cross-sectional study of motor development among children after the Fontan procedure

Published online by Cambridge University Press:  24 January 2012

Patricia E. Longmuir*
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada Department of Physical Therapy, University of Toronto, Toronto, Canada
Laura Banks
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Brian W. McCrindle
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada Departments of Pediatrics and Nutritional Sciences, University of Toronto, Toronto, Canada
*
Correspondence to: Dr P. Longmuir, Healthy Active Living and Obesity Research Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road Ottawa, Ontario, Canada K1H 8L1. Tel: +613 738 3908; Fax: +613 738 4800; E-mail: [email protected]

Abstract

Objectives

To determine the gross motor skills of school-aged children after the Fontan procedure and compare the locomotor and object control skills with normative data.

Study design

This study followed a cross-sectional design.

Setting

This study was based on hospital outpatient visit, with accelerometry conducted at home.

Patients

This study included 55 patients, including 22 girls in the age group of 6–10 years, 5.1 years after Fontan.

Main outcome measures

Test of Gross Motor Development – Version 2, daily activity by accelerometer, medical history review, child and parent perceptions of activity.

Results

Being involved in active team sports increased locomotor percentile score by 10.3 points (CI: 4.4, 16.1). Preference for weekend outdoor activities (6.9, CI: 2.0, 11.8), performing at least 30 minutes of moderate-to-vigorous physical activity daily (24.5, CI: 7.3, 41.8), and reporting that parents seldom criticise the child's physical activity (21.8, CI: 8.9, 34.8) were also associated with higher locomotor percentile scores (p < 0.01). Object control percentile scores were higher (p < 0.03) with involvement in formal instruction (5.9, CI: 1.1, 10.6) and being restricted to “activities within comfortable limits” (27.6, CI: 7.7, 47.5). Older chronological age (r = 0.28), a more complicated medical history (r = 0.36), and older age at Fontan (r = 0.28) were associated with greater skill delay (p < 0.04).

Conclusions

Children after Fontan attain basic motor skills at a later age than their peers, and deficits continue for more complex skills as age increases, suggesting a need for longitudinal monitoring of gross motor skill development through the elementary school years. Future research might investigate whether a gross motor skill rehabilitation programme can provide these children with the motor skills needed to successfully participate in a physically active lifestyle with peers.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2012

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References

1. McCrindle, BW. Commentary. J Thorac Cardiovasc Surg 1999; 188: 10521055.CrossRefGoogle Scholar
2. McCrindle, BW, Williams, RV, Mital, S, et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509514.CrossRefGoogle ScholarPubMed
3. Snookes, SH, Gunn, JK, Eldridge, BJ, et al. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010; 125: e818e827.CrossRefGoogle ScholarPubMed
4. Williams, HG, Pfeiffer, KA, O'Neill, JR, et al. Motor skill performance and physical activity in preschool children. Obesity (Silver Spring) 2008; 16: 14211426.CrossRefGoogle ScholarPubMed
5. Dittrich, H, Buhrer, C, Grimmer, I, Dittrich, S, Abdul-khaliq, H, Lange, PE. Neurodevelopment at 1 year of age in infants with congenital heart disease. Heart 2003; 89: 436441.CrossRefGoogle ScholarPubMed
6. Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141: 5158.CrossRefGoogle ScholarPubMed
7. Ulrich, DA. Test of Gross Motor Development (TGMD-2). PRO-ED, Austin, TX, 2000.Google Scholar
8. Sallis, JF, Prochaska, JJ, Taylor, WC, Hill, JO, Geraci, JC. Correlates of physical activity in a national sample of girls and boys in grades 4 through 12. Health Psychol 1999; 18: 410415.CrossRefGoogle Scholar
9. Hay, JA. Adequacy in and predilection for physical activity in children. Clin J Sport Med 1992; 2: 192201.CrossRefGoogle Scholar
10. Garcia, AW, Broda, MA, Frenn, M, Coviak, C, Pender, NJ, Ronis, DL. Gender and developmental differences in exercise beliefs among youth and prediction of their exercise behavior. J Sch Health 1995; 65: 213219.CrossRefGoogle ScholarPubMed
11. Medical Research Council of Canada, Natural Sciences and Engineering Research Council of Canada and Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Medical Research Council of Canada, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada, Ottawa, Ontario, 1998, p. 90.Google Scholar
12. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. New York Heart Association, Boston, 1994, pp. 253256.Google Scholar
13. Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 5560.CrossRefGoogle ScholarPubMed
14. Goldberg, CS, Schwartz, EM, Brunberg, JA, et al. Neurodevelopmental outcome of patients after the Fontan operation: a comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions. J Pediatr 2000; 137: 646652.CrossRefGoogle ScholarPubMed
15. Bjarnason-Wehrens, B, Dordel, S, Schickendantz, S, et al. Motor development in children with congenital cardiac diseases compared to their healthy peers. Cardiol Young 2007; 17: 487498.CrossRefGoogle ScholarPubMed
16. Holm, I, Fredriksen, PM, Fosdahl, MA, Olstad, M, Vollestad, N. Impaired motor competence in school-aged children with complex congenital heart disease. Arch Pediatr Adolesc Med 2007; 161: 945950.CrossRefGoogle ScholarPubMed
17. Eccles, JS, Harold, RD. Gender differences in sport involvement: applying the Eccles expectancy-value model. J Appl Sport Psychol 1991; 3: 735.CrossRefGoogle Scholar
18. Driscoll, DJ, Durongpisitkul, K. Exercise testing after the Fontan operation. Pediatr Cardiol 1999; 20: 5759; discussion 60.CrossRefGoogle ScholarPubMed
19. Klavora, P. Foundations of Exercise Science. Sport Books Publisher, Toronto, Ontario, 2004.Google Scholar