Exercise as it relates to Disease/The effects of exercise programing on adolescents and children with visual impairments

This is a critique of the research article by Pineio Christodoulou exploring the effects of exercise programming on adolescents and children with visual impairments, from the Open Science Journal of Education. This was written as an assignment for the unit Health, Disease and Exercise at the University of Canberra.

What is the background to this research?
Whilst it is evident there are many health benefits associated with physical activity, boundaries exist for those who are visually impaired or blind in regards to how they participate in exercise. Additionally, those who are visually impaired are less likely to participate in exercise in comparison to those who have clear vision. The importance of implementing physical activity at a young age reinforces better behavioural attitudes towards exercise into adulthood. Through the implementation of programming, adolescents and children with visual impairments or blindness demonstrated an improvement in their motor skills, physical attributes and well being. These skills can be utilised into adulthood to prevent the occurrence of falls and poor lifestyle decisions which are more prevalent in the blind and visually impaired population.

The study examined the effects of an adaptive physical activity program on motor development of children and adolescents with visual impairment. Children with visual impairment show deficits in their motor development, resulting in lower levels of resistance, cardiovascular fitness, and physical performance in comparison to one with clear vision. Additionally, parental knowledge about physical activity for the visually impaired is limited, establishing a barrier for how visually impaired children can participate in physical activity and exercise. The necessity for implementing exercise programs for children and adolescents with visual impairment are heightened to further their quality of life and improve multiple health outcomes.

The purpose of this research was to improve the balance and motor skill ability of the participating children. The Bruininks Oseretsky Test of Motor Proficiency (BOTMP) psychometric assessment was utilised to evaluate the outcomes. Assessing a field that is currently poorly documented, this study deems to be valuable as it deepens our understanding on the importance of physical activity for the above outcomes.

Where is the research from?
This study consisted of 24 children and adolescents with visual impairment aged between 6–14 years of age. 12 of the participants were allocated in an exercise group, with the remaining 12 being part of the control group that did not participate in any form of exercise. This sample size was selected from a school in Greece. There is little information known about the lead author, Pineio Christodoulou, however the same group of authors have participated in studies together, directed towards autism and visual impairment, assessing both adaptive behaviours and the effects of exercise. The study was published in the Open Science Journal of Education vol.5 (2017).

What kind of research was this?
This study implements a matched subject design, comparing a group of 12 who have been involved in an exercise program for 12 executive weeks, with two sessions a week, with a group of 12 that did not participate in exercise. To improve the equivalence between the groups, the individuals were distributed as homogeneously as possible with similar characteristics in relation to some variables (age, sex, time of visual disability, degree of visual disability and somatometric characteristics). Those with additional disabilities were excluded from the study.

What did the research involve?
Data was collected from the 24 visually impaired or blind children and adolescents using the Bruininks Oseretsky Test of Motor Proficiency (BOTMP) psychometric instrument. Notably, the assessment was modified to address the specific demands of visually impaired individuals. Implementing the BOTMP psychometric instrument, the program was orientated to address the following motor components:

1.Fine motor precision 2.Fine motor integration 3.Dexterity of hands 4.Bilateral motor coordination 5.Balance 6.Flexibility 7.Coordinate of the upper limbs 8.Development of power

Evidently, the two groups were not randomly assigned, rather distributed based on physical characteristics. Consequently, matched subject designs are limited, as they don't address all the variables and barriers of the visually impaired population. Despite this, they still maintain a good degree of validity and can be considered appropriate for the small sample size of 24 participants.

The BOTMP psychometric instrument is a tool utilised to provide an objective measure on the participants motor skill ability. This assessment uses a motor-scale which objectively scores their movement based on completion and/or range of motion. This measure increases the validity of the assessment, minimising subjective input from scorers.

What were the basic results?
The participants were examined pre- and post-intervention, providing an insight into the changes in their motor skill ability. Illustrated through the BOTMP scoring, the intervention group highlighted improvements in their motor development. Contrastingly, the control group who did not participate in exercise demonstrated no statistically significant change following the intervention.

Notably, the population that participated in exercise were categorised ‘well below average’ - in regards to their motor skill ability, prior to the intervention and were categorised ‘below average’ following the intervention. Therefore whilst there are still improvements in their motor ability, it remains below standard.

What conclusions can we take from this research?
Exercise programs that are tailored to the specific needs of blind and visually impaired children and adolescents highlight an improvement in their general motor ability. With greater levels of motor control, the population possesses higher levels of balance which is useful in injury prevention and physical well-being.

Further studies should investigate similar interventions, perhaps in different age groups, and dividing the results into different levels of visual impairment severity. Additional factors such as psychological readiness and behavioural attitudes should also be examined to better understand the population’s approach to physical activity, and its role in how confidently this group performs different motor skills.

Practical advice
Specialised exercise programs to improve motor control and balance in visually impaired or blind populations deem to be effective. Represented through this study, two exercise sessions a week that are participated in a leisurely manner highlight potential to improve motor control long term. Depending on the assessment used, it must be modified to address the demands of the visually impaired, and other health related needs must be met.

Further information/resources

 * Relationship of mptpr development to adaptive behaviour of children and adolescents with visual impairment
 * Motor activity in children who are blind or partially sighted