Home-Based Balance Training on Balance and Mobility in Persons With Multiple Sclerosis: A Systematic Review and Meta-analysis.

OBJECTIVES: To (1) examine the effects of home-based balance training on balance and mobility outcomes; (2) evaluate comparable effects between home- and center-based balance training; (3) determine the effects of different levels of supervision on treatment effects; and (4) investigate dose-response relationships of home-based balance training on balance and mobility performance in persons with multiple sclerosis (MS). DATA SOURCES: Literature searches were conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2023. Other literature sources included website and citation searches. STUDY SELECTION: The study included randomized controlled trials of home-based balance training that included balance and mobility outcomes in persons with MS. DATA EXTRACTION: Data extracted from each study included (1) number of participants; (2) dropout rate; (3) sex; (4) MS phenotype; (5) age; (6) Expanded Disability Status Scale (range); (7) exercise dose; (8) level of supervision; (9) type of intervention; (10) exercise progression; (11) type of control; and (12) outcomes measures. For the meta-analysis, mean and SD of the balance and mobility outcomes in both the intervention and control groups were used. The methodological quality of included studies was evaluated by Tool for the Assessment of Study Quality and Reporting in Exercise. DATA SYNTHESIS: Eleven studies were identified in this systematic review and meta-analysis. Each balance and mobility outcome was standardized using Hedges' g. CONCLUSIONS: This meta-analysis revealed comparable results between home- and center-based balance training in terms of balance and mobility improvement. There was also no evidence for the superiority of home-based balance training over no training except for static steady-state balance. This study revealed that training sessions (>36 sessions) and total exercise time (>1100min) were significant moderators for overall balance improvements. Results also indicated that, when designing future interventions, at least an indirect level of supervision (eg, weekly or biweekly phone/video calls) is warranted to maintain adherence.

Poor Physical Health in Caregivers of Children with ADHD or ASD and its Association with Health Risk Behaviours: NHIS 2016-2018.

BACKGROUND: There is a dearth of evidence regarding physical health problems and health risk behaviours (e.g., drinking, physical inactivity, smoking, and suboptimal sleep behaviour) in caregivers of children with attention deficit hyperactivity disorder or autism spectrum disorder (CCAA). The purposes of the current study were to examine differences in physical health problems between CCAA and caregivers of children without attention deficit hyperactivity disorder and autism spectrum disorder (CCWAA) and to explore health risk behaviours associated with those problems. METHOD: Data from the 2016-2018 National Health Interview Survey were used in the current study. 10 common physical health problems were compared between CCAA and CCWAA by using multivariable logistic regressions. In addition, in order to detect associated health risk behaviours, decision tree analysis was performed for physical health problems in CCAA. RESULTS: Of the 10 physical health problems, caregivers of children with ADHD showed significantly higher likelihood of experiencing nine (arthritis, asthma, back pain, high cholesterol, diabetes, heart problems, hypertension, neck pain, obesity), compared to CCWAA. Caregivers of children with autism spectrum disorder (ASD) showed significantly higher likelihoods of experiencing two physical health problems compared to CCWAA. The decision tree analysis revealed that age (> 42 years), and suboptimal sleep behaviour (not 7-8 hours), and smoking (current smoker) were the frequent predictors for physical health problems in CCAA. CONCLUSION: The results of the current study represent an important milestone in further investigating physical health problems in CCAA.

A randomized parent-mediated physical activity intervention for autistic children.

The purpose of this study was to examine the immediate and post effects of a parent-mediated physical activity intervention on the fundamental motor skills of autistic children. We randomly assigned parent-child dyads (n = 31) of autistic children aged 4-11 years into three groups (workshop, an online, or control group). Each dyad participated in a 12-week intervention and was given adapted physical activity equipment and over 200 activities via a mobile application. Children were tested at the start and end of the intervention. The effect size (Cohen's d ) of the control group for pre-post locomotor and ball skill scores were 0.12 and 0.06, respectively, indicating small effect size. The effect size of the online group for pre-post locomotor and ball skill scores were 49 and 0.26, respectively, indicating medium and small effect sizes. The effect size of the in-person group for pre-post locomotor and ball skill scores were 1.18 and 0.82, respectively, indicating large effect sizes. The outcomes of this physical activity intervention suggest that parents may facilitate the acquisition of fundamental motor skills of their autistic children. Although these results are positive, there is a need to further identify effective interventions for fundamental motor skill development in autistic children. Clinical Trials ID: NCT05159102.

Parental Behavior Influences on Motor Skill Development in Young Children with Developmental Disabilities: A Two-Year Longitudinal Study.

Young children with developmental disabilities (DDs) experience motor skill deficits compared to their peers without disabilities. Even though parents play an important role in developing their children's motor skills, it has not been widely studied how parental behaviors influence motor skill development in young children with DDs. Therefore, the current study has two main purposes: (a) to examine early motor skill development of preschool aged children (3-5 years) with DDs longitudinally over a two-year period and (b) to longitudinally examine the relationship between parental behaviors and the motor skill development of young children with DDs. Fundamental motor skills (locomotor and object control skills) in 64 young children with DDs and their parent's behavior was measured at five time points when children were between the ages of three and five years. Multilevel modeling was used to examine motor skill progression in young children with DDs and to evaluate the longitudinal relationship between parenting behaviors and motor skill development in young children with DDs. Findings indicated that young children with DDs develop their motor skills in a non-linear fashion across two years. Young children with DDs who have parents with one standard deviation higher (+ SD) in the positive parental behavior than average showed a statistically significant linear increase in the standard scores of locomotor and object-control skills with age (b = 0.27, p = 0.01; b = 0.22, p < 0.01, respectively). This study highlights the importance of positive parenting behaviors in regard to promoting motor skills in young children with DDs.

Development of a survey measuring parental physical activity support in parents of children with disabilities.

PURPOSE: The purposes of the current study were to develop a questionnaire to measure parental physical activity (PA) support in parents of children with disabilities and to examine factors associated with parental PA support. MATERIALS AND METHODS: A questionnaire measuring parental PA support in parents of children with disabilities (PPSQ for PCD), consisting of three constructs (encouragement, co-PA, and logistic support) with 19 items, was initially developed and evaluated by the Confirmatory Factor Analysis. Three independent multiple regression analyses were conducted to examine associations between the three constructs and parental PA orientation variables. RESULTS: With the item deletion approach, the final model with 12 items (four items in each construct) was developed, which revealed an excellent model fit (x2= 78.42 [df = 51, p = .008], CFI = 0.98, GFI = 0.94. RMSEA = 0.05). The multiple regression analyses revealed that parental orientation variables were differently associated with each construct of the PPSQ for PCD. CONCLUSIONS: The PPSQ for PCD consists of three constructs, differently associated with parental orientation variables. This questionnaire can be used as an instrument to assess parental PA support. Implications for RehabilitationThe Parental Physical Activity Questionnaire (PPAQ) can be used to assess parental physical activity support in parents of children with disabilities.The PPAQ measures three constructs (i.e., types) of parental physical activity support including encouragement, co-physical activity, and logistic support.Parental physical activity orientations (e.g., importance, enjoyment, and behavior) are differently associated with each construct of parental physical activity support.

Understanding parental physical activity support in parents of children with developmental disabilities across two different countries.

BACKGROUND: It remains unclear if there is a difference between parental physical activity (PA) support in parents of children with developmental disabilities (DDs) and parental PA support in parents of children without DDs across countries. AIMS: The purposes of the current study were to examine parental PA support in parents of children with and without DDs from the United States and South Korea and to examine their parental PA support mechanism based on the theory of planned behavior (TPB). METHODS AND PROCEDURES: An online survey was used to measure demographic information, parental PA support, and four constructs of TPB in parents with and without DDs in the two countries (n = 277). One-way analysis of variance was used to compare parental PA support and the TPB constructs among the participants. Two separate path analyses were performed to examine associations between the TPB constructs and parental PA support in American parents of children with and without disabilities and South Korean parents of children with and without disabilities. OUTCOMES AND RESULTS: Parental PA support was significantly higher in American parents of children with DDs than in South Korean parents of children with DDs. Intention was significantly associated with parental PA support, and attitude was the strongest predictor for intention in both pathway models. CONCLUSIONS AND IMPLICATIONS: The difference in parental PA support between American parents of children with DDs and South Korean parents of children with DDs may exist. TPB-based intervention may be necessary in order to increase low parental PA support in South Korean parents of children with DDs.

The prevalence of health problems and their association with physical activity in caregivers of children with disabilities: 2018 National Health Interview Survey.

BACKGROUND: Caregivers of children with disabilities often experience poor health. One way for caregivers to promote their own health may be to participate in physical activity (PA). AIMS: The purpose of this study was to examine the association between PA and psychological and physical health problems in caregivers of children with disabilities. METHODS: The 2018 National Health Interview Survey (NHIS) data were used, and 890 household representatives were identified as caregivers of children with disabilities. Based on the national PA guidelines, caregivers were classified into three groups: inactive (IA), aerobically active (AA), and aerobically and muscularly active (AMA). RESULTS: Multivariable logistic regression indicated that the AMA group had a lower likelihood of reporting depression compared to the IA group (OR: 0.73 [95% confidence interval: 0.54, 0.98]). The AMA group also had a lower likelihood of reporting back pain and obesity compared to the IA group (OR:0.69 [95% confidence interval: 0.56, 0.84] and OR:0.63 [95% confidence interval: 0.52, 0.76], respectively). CONCLUSIONS: The results of the current study suggest that caregivers of children with disabilities may benefit from PA, especially from the combination of aerobic and muscle-strengthening PA.

The Effect of Physical Activity Interventions on Executive Function Among People with Neurodevelopmental Disorders: A Meta-Analysis.

The current meta-analysis comprehensively examined the effects of physical activity interventions on executive function among people with neurodevelopmental disorders. The meta-analysis included 34 studies with 1058 participants aged 5-33 years. Results indicated an overall significant medium effect of physical activity interventions on improving executive function in people with neurodevelopmental disorders under the random-effect model (Hedges' g = 0.56, p < .001). Significant moderators of the effects of physical activity intervention on executive function included age, intervention length and session time, executive function subdomains, and intervention dose (total minutes in the intervention). This meta-analysis provides support for the effectiveness of physical activity interventions on executive function among people with neurodevelopmental disorders. Future studies and limitations are discussed.

Physical activity behaviors in parents of children with disabilities: A systematic review.

BACKGROUND: Even though it has been widely known that parents influence physical activity (PA) behaviors of children without disabilities, there is no consensus about the effects of parents on PA behaviors of children with disabilities. AIMS: The purpose of this study was to systematically review published literature examining the effects of parents on PA behaviors of children with disabilities. METHODS: A systematic literature search was performed in three databases. OUTCOMES AND RESULTS: The search identified 13 studies which met predetermined inclusion criteria. Of the 13 studies, 10 studies were conducted in United States and Canada. The remaining three studies were from three different countries: Italy, Australia, and Hong Kong. From the 13 studies, 24 parental factors were identified and categorized into four different dimensions: a) participating in PA intervention (four factors included), b) parental support (three factors included), c) parental PA role modeling (five factors included), and d) parental importance of child's PA (three factors included). Six factors across three dimensions (i.e., participating in PA intervention, parental support, parental importance of their child's PA) were significantly and positively associated with PA behaviors in children with disabilities, but no factor in parental PA role modeling was significantly associated with PA behaviors in children with disabilities. CONCLUSIONS AND IMPLICATIONS: The associations between parental factors and PA behaviors in children with disabilities varied depending on the dimensions of the parental factors. Further studies are warranted to confirm the association between parental factors and PA behaviors in children with disabilities, including cross-cultural comparisons.

Parental Influence on the Physical Activity Behaviors of Young Children With Developmental Disabilities.

The purpose of this study was to test a modified conceptual model of the associations between parental supports and physical activity (PA) orientations and the PA behaviors of young children with developmental disabilities (DDs). In total, 135 parents of young children with DDs completed a questionnaire, which consisted of 67 questions. A pathway analysis indicated that tangible and intangible parental supports were significantly associated with PA behaviors in young children with DDs (ß = 0.26, p = .01, and ß = 0.24, p = .02, respectively). Tangible parental support was positively associated with parents' PA behaviors and PA enjoyment (ß = 0.22, p < .001, and ß = 0.13, p = .04, respectively). Intangible parental support was positively associated with parents' PA behaviors and PA importance (ß = 0.19, p = .05, and ß = 0.33, p < .001, respectively). In addition, parental PA behaviors and parents' perceptions of their children's motor performance were both directly associated with PA behaviors in young children with DDs. These results highlight the importance of parental support and PA orientations in relation to the PA behaviors of young children with DDs.

Parental influences on parent-reported motor skills in young children with developmental disabilities.

BACKGROUND: Young children with developmental disabilities (DDs) often experience motor skill deficits. Although parents play an important role in developing their children's motor skills, the association between parents of young children with DDs and those children's motor skills has not been widely studied. OBJECTIVE: The purpose of this study was to cross-sectionally examine the pathway by which parental physical activity (PA) support, explicit modeling, and child's PA are associated with motor skills in young children with DDs. METHOD: One hundred and thirty-five parents of young children (5-7 years) with DDs completed an online questionnaire which included questions about parental PA support, parental explicit PA modeling, children's PA behavior and children's motor skill variables. RESULTS: Pathway analysis was conducted to examine the pathways between parental tangible support and explicit modeling and motor skills in young children with DDs. The pathway analysis indicated that parental tangible support and explicit modeling are significantly associated with PA behaviors in young children with DDs, which in turn, are associated with their motor skills. CONCLUSIONS: The results from this study suggest that young children with DDs may acquire motor skills by participating in PA. In addition, parents of young children with DDs can indirectly be associated with the motor skills of their children by supporting PA and becoming a PA role model. For parents of young children with DDs, increasing the PA behaviors of their children maybe away to improve their children's motor skills.

An inquiry into how parents of children with autism spectrum disorder interact with their children in a motor skill-based play setting.

BACKGROUND: Most studies examining parental behaviors of parents of young children with autism spectrum disorder (ASD) and typically developing (TD) children have taken place in free play settings and have primarily focused on examining social behaviors. Motor skill-based play settings, which are distinctly different from free play settings, have not been explicitly studied as it relates to parental behaviors in these environments. AIMS: The purpose of this study was to examine parental behaviors of parents of children with and without ASD in two distinctly different play settings. METHODS: Parental behaviors of eighteen parents of children with (n = 9) and without ASD (n = 9) were examined by observation in different play settings (free play [a social-play/traditional play based setting] and a motor skill-based play setting). The examined parental behaviors included parental encouragement, negativity, sensitivity, detachment, and intrusiveness. A 2 × 2 (group × play setting) repeated measures of ANOVA was conducted to examine the main effect of group (TD vs ASD) and play setting (a social-play based setting and a motor skill-based setting) and the interaction effect between group and play setting on parental behaviors. Post-hoc independent t-tests between groups in each setting were conducted to follow-up on significant interactions indicated in the repeated measures of ANOVA RESULTS: The repeated measures ANOVA revealed that parental encouragement showed a significant interaction effect, suggesting that the effect of group on parental encouragement depended on play setting. A post-hoc analysis revealed that parents of children with ASD showed statistically significant lower parental encouragement in a motor skill-based play setting but not in a social-play based setting compared to parents of TD children. Moreover, there was a main effect of group (parents of children with ASD vs. parents of TD children) on parental intrusiveness indicating that the mean parental intrusiveness on children with ASD was significantly higher than parents of TD children across both play settings. There were no statistically significant main or interaction effects on the other parental behaviors (parental negativity, sensitivity, and detachment) between groups. CONCLUSIONS AND IMPLICATIONS: The current study indicated parental encouragement differences between parents of children with ASD and parents of TD children varied based on the play setting. These results identify a need to examine parental behaviors, especially parental encouragement and parental intrusiveness across various types of play settings. Furthermore, as parents of children with ASD displayed lower parental encouragement in a motor skill-based play setting compared to parents of TD children, future studies are warranted to improve parental encouragement of parents of children with ASD in a motor skill-based play setting.

Observations of playground play during elementary school recess.

OBJECTIVE: The purpose of the current study was to examine reliability and validity evidence for an observational measure of playground play during recess. Observational data of what children played at recess were collected at 236 recess sessions across 26 urban elementary schools. An inductive content analysis of children's type of play and activity engagement during recess was conducted to categorize activities. Inter-rater reliability of observations was assessed at 49 points that spanned 22 unique recess periods at four different schools. Reliability data were collected during the winter and spring seasons. A multivariate analysis of variance was conducted to examine differences in play and activity patterns between genders, and between schools implementing recess interventions (e.g., structured play environment) and schools with no recess intervention. RESULTS: Results of the content analysis yielded eight playground play and activity categories, all with high levels of inter-rater reliability (ICCs > .90). Significant differences in children's play and activity patterns emerged between genders and across recess intervention conditions. Engagement in 'sports and organized activities' and 'non-engagement in play' contributed most to the separation between boys and girls, while 'non-engagement in play' contributed most to the separation between recess intervention and non-intervention schools.