Medical scientific information
 

MOTOR REHABILITATION PROGRAMS FOR CHILDREN WITH CONGENITAL HEART DISEASE - A STRATEGY FOR IMPROVING QUALITY OF LIFE

Sticker, E.J. , Bjarnason-Wehrens, B. , Dordel, S , Leurs, S. , Schickendantz, S. Psychological Institute, University of Cologne, Germany;
Institute of Cardiology and Sports Medicine, German Sport University Cologne,
Institute of Rehabilitation, German Sport University Cologne,
Department for Pediatric Cardiology of the University of Cologne, Germany.
 
Introduction. Children with congenital heart disease (CHD) are often unduly restricted in their physical activities. The reasons for this can be overprotection or lack of information on the part of parents, educators and teachers. This may lead to a vicious cycle of continuing motor deprivation leading to increasing motor deficits and psychosocial problems such as social isolation and low self esteem. In the early nineties exercise groups for CHD children were started to counterbalance these negative effects. There are now about 20 such groups in Germany. Only a few of these groups have been scientifically evaluated. Using detailed data gathered in Cologne since 1994, we sought to assess to what degree motor an psychosocial development improved in CHD children who participated in such exercise groups.
 
Materials and Methods. Between 1994 and 1999 six groups of children participated in an 8-month exercise program, consisting of 1.5 hour weekly sessions. It was tailored to the special cardiac status of CHD children by including predominantly sport activities with special emphasis on motor coordination, which require minimum demands on circulation. The sample comprised a total of 76 children aged between 4 and 14 years (Phase I, 1994-96: 38 children, 7-14 years; Phase II, 1997-1999: 38 children, 4-8 years). Comprehensive medical, motor and psychological tests were carried out before and after the program.
 
Results. There was a significant improvement in the motor coordination of phase I school-children, many of whom were initially deficient in this. Additionally they improved their speed of perception, starting the program with average pretest scores. For more than one third of the children, self confidence and anxiety about sports changed from extreme low or high scores in the pretest to average scores in the posttest - a favourable result because of approximation to "normality". Also, more than one third of the children became more competent in socializing with their peers. The preschool children (phase II) showed less motor and psychosocial deficits initially than the school children. Less dramatic positive changes were thus encountered with the exercise program. Still, they increased their perceptual speed and reported a larger number of friends.
 
Conclusions. School-children with CHD often exhibit significant deficits in motor and psychosocial development which can be minimized by a psychomotor training program. Preschool children with CHD show less pronounced deficits than school-children. Nevertheless, participation in a psychomotor training program can work to prevent the development of deficits and help these children in gaining age-appropriate progress. CHD children, the younger, the better, should all get the opportunity to participate in this kind of psychomotor training, in order to increase or - given a high baseline - to stabilize their quality of life.

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