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Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 19-22

Gross motor deficits in cerebral palsy, autistic spectrum disorder, mental retardation, and Down syndrome children: A prevalence study

Department of Physiotherapy, Tilak Maharashtra Vidhyapeeth University, Pune, Maharashtra, India

Date of Web Publication17-Jul-2017

Correspondence Address:
Pravin Pandurang Gawali
Tilak Maharashtra Vidhyapeeth University, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_38_16

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Introduction: Gross motor skills are those which require the movement of the whole body and the involvement of the core stabilizing muscles of the body so as to perform activities of daily living and gross motor deficits refer to the lack of this coordination of muscles. Purpose: This study was conducted to contribute to the researches on gross motor coordination to provide systemic and appropriate physiotherapy guidance in children with motor deficits. Materials and Methods: We assessed the gross motor deficits in four different groups of children – cerebral palsy (CP), autism spectrum disorder (ASD), mental retardation (MR), and Down syndrome (DS), using the Charlop-Atwell scale. Forty children – 10 from each of these groups – were assessed. All children were between the ages of 6 years and 17 years. After the filling of these details and having received the consent of the child's guardian, they were asked to perform 6 different activities. These activities or categories were assessed both subjectively and objectively, and score was given on the basis of the Charlop-Atwell scale. These scores were then analyzed to get the results and draw conclusions. Results: The percent of motor deficits of CP was 65.56% followed by ASD, MR, and DS having 57.76%, 55.26%, and 38.98% motor deficits. Conclusion: CP showed the highest and DS children showed the lowest percent of motor deficits. There was a significant difference among the groups (P = 0.042).

Keywords: Autistic spectrum disorder, cerebral palsy, Down syndrome, gross motor deficits, mental retardation

How to cite this article:
Gawali PP, Jain SS, Yeole U, Adkitte R, Gharote G. Gross motor deficits in cerebral palsy, autistic spectrum disorder, mental retardation, and Down syndrome children: A prevalence study. Saudi J Health Sci 2017;6:19-22

How to cite this URL:
Gawali PP, Jain SS, Yeole U, Adkitte R, Gharote G. Gross motor deficits in cerebral palsy, autistic spectrum disorder, mental retardation, and Down syndrome children: A prevalence study. Saudi J Health Sci [serial online] 2017 [cited 2021 May 13];6:19-22. Available from: https://www.saudijhealthsci.org/text.asp?2017/6/1/19/210810

  Introduction Top

“Development can be defined as the maturation of the function with age and is reflected by the attainment of various milestones, sequentially.”[1]

Every child's body develops rapidly in the early and middle childhood years of life. As the child naturally enjoys the active play and desires to have an interaction with others and the environment, it creates great opportunities to the professionals of child care and thus supports the child's gross motor development.[2] Gross motor skills are those which require the movement of the whole body and the involvement of the large, i.e., the core stabilizing muscles of the body so as to perform activities of daily living (ADL) such as standing upright, walking, sitting upright, and running. It also involves the eye-to-hand coordination skills such as throwing, catching, and kicking activities.[3] Motor tasks can be performed to evaluate gross motor functions in children. Any deviation from the normal motor performance, observed over different parameters, can be indicative of abnormal motor performance.[4]

Cerebral palsy (CP) children have various neurological deficits which tend to interfere with the normal motor functions and ADLs. Impairments of CP consist of both neuromuscular and musculoskeletal problems such as dyscoordination, spasticity, muscle contractures, selective loss of motor control, and weakness.[5],[6] CP can be classified on the basis of the type and the distribution of impairments: hemiplegia, ataxic diplegia, spastic diplegia, dyskinetic quadriplegia, and mixed type.[5],[7] Though spasticity and dyscoordination are a few components responsible for the gross motor deficits, a routine assessment of the spasticity of the muscle groups and range of motion (ROM) of joints could give the correlation of the impairments and the gross motor deficits.[5]

Autism spectrum disorder (ASD) is a neurodevelopmental condition, starting from childhood and so being chronic. It affects approximately 1 in 88 children.[8],[9],[10] This childhood condition is characterized by core impairments in social and repetitive behavior.[8],[11] Children suffering from ASD have impairments in their fine and gross motor skills, motor planning, motor coordination, and praxis.[8],[12],[13],[14] Each developmental motor milestone may show these signs of motor impairments and is considered as early warning signs of ASD.[8],[14],[15],[16] Children with ASD typically show delayed milestones. At the age of 4 months, they show asymmetrical posture in prone lying and this remains throughout the 1st year of life.[8],[14],[16] During the rolling stage, some children with ASD cannot roll at all while others show altered patterns. Sitting maybe achieved by 6 months, but due to unequal weight distribution, there maybe forward or backward falls.[8],[14],[17] Crawling may also be asymmetrical and unsynchronized.[8],[14],[18] Standing is impaired with signs of akinesia.[8],[14] Walking is usually delayed with short steps and asymmetrical gait, similar to a gait of the Parkinson's individual.[8],[14],[17],[19] Along with all these, there is asymmetrical posture, dysregulation of infantile reflexes, and dysfunction of the vestibular system.[8],[14],[15],[18],[19]

Down syndrome (DS) is a condition involving multiple congenital abnormalities, arising from an extra chromosome 21, the so-called trisomy 21. It is a common disorder in which the most obvious symptom remains the mental handicap. However, Carr in her study in 1970 concluded that a motor handicap is more significant than the mental handicap.[20] Children with DS usually exhibit delayed motor milestones such as grasping, rolling, sitting, standing, and walking. The progression varies with some being slow in reaching the milestones, while the others attaining the milestones, as early as a typical infant.[21] The motor development of children with DS follows the same basic order, but their attainment age is somewhat more as compared to the normal infants.[22],[23] Children with DS usually exhibit “clumsy” movements.[24] DS children have flaccid muscle tone and are often referred to as “floppy,” and this stage of hypotonia is responsible for the poor motor function. They take longer time and require more practice to perform their tasks. The tasks requiring balance may seem to be difficult for them.[21] However, overall early interventions that aim at all aspects of development may help gain motor development much earlier than expected.[21],[25]

The intellectual disabilities have a great impact on the normal school activities such as reading, writing, and arithmetic. Due to the variations in the nature of the intellectual disability, there are differences noted in their motor development. Children with mild intellectual disabilities usually exhibit delays in performing their ADLs. They often try to cope with the basic activities such as feeding themselves, dressing, and hygiene. Although children with mild intellectual disabilities also exhibit a delay in motor development, this deficit is more pronounced in children with moderate and severe intellectual disabilities. Children with moderate intellectual disabilities have milder deficits when compared to children with severe disabilities and manifest pronunciation deficits, lack of movement coordination, and impaired balance. Children with severe intellectual disabilities are observed with profound deficits in motor skills, even manifesting in adulthood which results in extremes of cases with total immobility and severe movement restrictions.[26],[27],[28]

Many researches have been conducted to study the gross motor deficits in these individual groups and how it affects the ADL. The Charlop-Atwell scale used in this study assesses the motor deficits in an objective and subjective manner. A systemic overview on the gross motor skills of these children could add to an understanding of the motor deficit they persist with. This study thus aims to find the incidence of gross motor deficits in CP, ASD, MR, and DS children.

  Materials and Methods Top

This was an observational prevalence-based study. Hundred and twenty-eight children were evaluated, out of which 40 children – 10 from each group – were selected based on the convenient sampling. The consent of their guardian was taken before assessment. Their evaluation form was filled to get their details such as name, age, sex, institution, and diagnosis. They were assessed for their motor coordination on the basis of the Charlop-Atwell scale. This scale had six components – jumping jacks, jump and face turn, hopping on one foot, walking like a prehistoric animal, scarf twirl, and tiptoe balance. Each of the components of the scale was assessed to get a score out of 72. These scores were evaluated to check which of the group of neuromotor disorder had the highest degree of gross motor deficit. Percentage of their motor deficit was calculated based on the total scores attained and conclusions were drawn.

  Results Top

The results include the mean and standard deviations of the age, individual category scores, and the total score. The results were calculated using the SPSS 19 developed by IBM, Armonk, North Castle, New York, United States in October 2010 and compiled using Microsoft Windows 8.1 Office Suite.

[Table 1] shows mean age and standard deviation of the four groups.
Table 1: Mean age and standard deviation of the four groups of children

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[Table 2] shows the mean scores of the categories assessed and the mean total score.
Table 2: Mean scores and standard deviation of different categories and mean total score

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[Graph 1] shows the percentage of motor deficits. There is a significant difference in the gross motor deficits among the four groups – CP, ASD, DS, and MR with P = 0.042.

  Discussion Top

Owing to the scores, CP children showed the highest percent of motor deficits. The DS children were able to perform the activities with quiet ease and showed the lowest percent of motor deficit as compared to the other three groups.

Sigrid Ostensjø et al. in their study described CP as a multidimensional disorder and from their results concluded that the motor impairments in CP such as spasticity and restricted ROM are closely related to gross motor control. They also said that gross motor control was not only dependent on the motor impairments, and there may also be other causes for the gross motor deficits.[5] A variety of pathological reasons such as cerebral atrophy, microcephaly, degeneration of basal ganglia, and cerebral lesions are observed mainly due to perinatal hypoxic brain damage, acid–base imbalance, intrauterine or acquired infections, indirect hyperbilirubinemia, or brain trauma.[1] These different factors are responsible for the motor impairments and the reason for the high percent of the gross motor deficits CP children showed.

Memari et al. in their study on ASD children discuss that there are many areas in the brain responsible for the motor control, and direct injury to these areas or indirect injuries to the brain stem, thalamus, or hypothalamus can cause motor deficits. Brain damage due to hypoxia or trauma and a genetic predisposition tend to hamper these motor functions and thus cause gross motor deficits.[8]

Most of the children with mental retardation present with behavioral abnormalities such as hyperactivity, short span of attention, easy distractibility, poor concentration, poor memory, impulsiveness, awkward and clumsy movements, disturbed sleep, emotional instability, and frustration. These are associated with defects in the musculoskeletal system, vision, speech or hearing, and the probable reason for the gross motor deficits.[1] It is also stated by Zikl et al. that even though people with mental retardation show delays in motor development, the mild form only show a slight delay, especially in childhood. The moderate form has less motor delay as compared to the severe form while the severe form shows profound delay in motor development even during adulthood.[26]

In DS, also the neuroanatomical disturbances are the basis for the motor impairments these children have. Until the recent 30 years, there was this concept that the children with DS only suffered from a mental handicap, and the delay in motor development was not said to be that significant. However, Carr in her study concluded that the mental handicap, even though the major symptom to be noticed, the DS children had motor impairments as well which was quiet a significant factor. Her study gave a clear idea about how there is a delay in the time of attaining the motor milestones and probably the reason for the gross motor deficit. However, the percent of motor deficit was the lowest for these children and is maybe due to the behavioral abnormalities only and not directly a motor impairment causing this deficit.[20]

  Conclusion Top

We thus concluded that CP children showed the highest percent of motor deficit when compared to the other three groups – ASD, MR, and DS.

DS children showed the lowest deficit in their gross motor skills.

The ASD and MR groups did not vary much among themselves.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ghai OP, Paul VK, Bagga A. Essential Pediatrics. 7th ed. New Delhi, India: CBS Publishers and Distributors Pvt. Ltd.; 2010.  Back to cited text no. 1
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Šlachtová M, Neumannová K, Dupalová D. Signs of abnormal motor performance in preschool children. Acta Univ Palacki Olomuc Gymn 2013;43:25-31.  Back to cited text no. 4
Ostensjø S, Carlberg EB, Vøllestad NK. Motor impairments in young children with cerebral palsy: Relationship to gross motor function and everyday activities. Dev Med Child Neurol 2004;46:580-9.  Back to cited text no. 5
Gormley ME Jr. Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. Pediatr Rehabil 2001;4:5-16.  Back to cited text no. 6
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Teitelbaum P, Teitelbaum O, Nye J, Fryman J, Maurer RG. Movement analysis in infancy may be useful for early diagnosis of autism. Proc Natl Acad Sci U S A 1998;95:13982-7.  Back to cited text no. 14
Flanagan JE, Landa R, Bhat A, Bauman M. Head lag in infants at risk for autism: A preliminary study. Am J Occup Ther 2012;66:577-85.  Back to cited text no. 15
Esposito G, Venuti P, Maestro S, Muratori F. An exploration of symmetry in early autism spectrum disorders: Analysis of lying. Brain Dev 2009;31:131-8.  Back to cited text no. 16
Esposito G, Venuti P. Symmetry in infancy: Analysis of motor development in autism spectrum disorders. Symmetry 2009;1:215-25.  Back to cited text no. 17
Teitelbaum O, Benton T, Shah PK, Prince A, Kelly JL, Teitelbaum P. Eshkol-Wachman movement notation in diagnosis: The early detection of Asperger's syndrome. Proc Natl Acad Sci U S A 2004;101:11909-14.  Back to cited text no. 18
Bhat AN, Galloway JC, Landa RJ. Relation between early motor delay and later communication delay in infants at risk for autism. Infant Behav Dev 2012;35:838-46.  Back to cited text no. 19
Virji-Babul N, Kerns K, Zhou E, Kapur A, Shiffrar M. Perceptual-motor deficits in children with Down syndrome: Implications for intervention. Down Syndrome Research and Practice 2006;10:74-82.  Back to cited text no. 20
Sacks B, Buckley S. What do we know about the movement abilities of children with Downs syndrome? Int Educ Postgrad Semin 2014;2:131-41.  Back to cited text no. 21
Sacks B, Buckley S. Motor Development for Individuals with Down Syndrome: An Overview. Portsmouth, UK: The Down Syndrome Educational Trust; 2003.  Back to cited text no. 22
Winders PC. Gross Motor Skills in Children with Downs Syndrome. Bethesda, MA: Woodbine House; 1997.  Back to cited text no. 23
Latash ML. Motor coordination in downs syndrome: The role of adaptive changes. In: Weeks DJ, Chua R, Elliott D, editors. Perceptual Motor Behavior in Downs Syndrome. Champaign, IL: Human Kinetics; 2000. p. 199-224.  Back to cited text no. 24
Connolly BH, Morgan S, Russell FF. Evaluation of children with Down syndrome who participated in an early intervention program. Second follow-up study. Phys Ther 1984;64:1515-9.  Back to cited text no. 25
Zikl P, Holoubková N, Karásková H, Veselíková TB. Gross motor skills of children with mild intellectual disabilities. World Acad Sci Eng Technol Int J Soc Behav Educ Econ Manage Eng 2013;7:2789-95.  Back to cited text no. 26
Beirne-Smith M, Patton JR, Kim SH. Mental Retardation. New Jersey: Pearson; 2006.  Back to cited text no. 27
American Association on Intellectual and Develop intellectual Disabilities. Definition of Intellectual Disability; 2011. Available from: http://www.aamr.org/content_100.cfm?navID=21. [Last cite on 2013 Jan 20].  Back to cited text no. 28


  [Table 1], [Table 2]


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