Date Published: March 29, 2018
Author(s): Yolandi Brink, John Cockcroft, Soraya Seedat, Philip May, Wendy Kalberg, Quinette Louw.
Postural control may be impaired in children with foetal alcohol spectrum disorders (FASD). The study assessed the protocol feasibility in terms of (1) recruiting children with FASD in a rural, small town; (2) using the measurement instruments in a real-life setting; (3) the one-leg standing (OLS) task and (4) presenting preliminary results on postural stability of children with and without FASD.
Nine-year-old children diagnosed with and without FASD were invited to participate. Twenty-eight children performed OLS. Feasibility outcomes included recruitment, measurement instrument use and task instruction. Postural stability outcomes included standing duration, centre of pressure (COP) and body segment acceleration.
Participants recruitment was feasible in terms of the (1) ability to sample a reasonable participant number in a rural town setting and the capacity to increase the sample size if more schools are included in the sampling frame and (2) use of assent and consent forms that were appropriate for this population. The measurement instruments were user-friendly, cost-effective and time-efficient. Instructions for the task require amendment to address foot placement of the non-weight–bearing leg. There was a significant difference between cases and controls on mean COP velocity (p = 0.001) and the pelvis segment acceleration in the mediolateral direction (p = 0.01) and the anteroposterior direction (p = 0.027). The control children took longer to achieve postural control. The girls demonstrated a significant difference for the COP anteroposterior displacement (p = 0.008) and velocity (p = 0.049).
The recruitment of children with and without FASD in a rural, small town and the administration of measurement instruments in a real-life, school-based setting was feasible. However, the verbal instructions for the task require revision. The male control group took longer to achieve postural control because the task was performed differently between the two groups. However, the case girls were slower to achieve postural control than control girls though performing the task similarly.
Foetal alcohol syndrome (FAS) represents the extreme end of a continuum of foetal alcohol spectrum disorders (FASD) and is the most common birth defect in South Africa, affecting more than one million South Africans (Bulletin of the World Health Organization 2011; Riley, Infante & Warren 2011). Extensive research of FASD, which includes FAS, partial FAS (PFAS) and alcohol-related neurodevelopmental disorder (ARND) has been conducted in rural or small-town settings in the Western Cape Province of South Africa, where 13.5%–20.8% children have been diagnosed with FASD (9.1%–10.0% with FAS; 7.0%–7.5% with PFAS; and 4.7% with ARND) (May et al. 2013; Olivier et al. 2013). This far exceeds the rates reported in other in-school studies internationally (May et al. 2009). The high occurrence of FAS in the Western Cape places a significant economic burden on the country as the estimated annual burden spent on the management of children with FAS is about 5% of the 2010/11 Department of Health’s budget (Crede et al. 2011). Because FAS is entirely preventable, preventive efforts would yield significant healthcare cost savings (Chersich et al. 2012). However, the occurrence of FAS in the wine region of the Western Cape has not reduced over the past decade (Crede et al. 2011). Therefore, cost-saving intervention strategies to improve the overall health of children with FAS are needed.
In this study we explored the feasibility of testing postural stability in children with and without FASD using portable 3D biomechanical analysis instruments in a rural school-based setting. The results of the feasibility testing are provided and the proposed amendments to the testing protocol are described in response to the findings of the study.
The study demonstrated the feasibility of (1) recruiting children with and without FASD in a rural, small town; (2) using the measurement instruments in a real-life, school-based setting and (3) performing the OLS task. There was a difference in mean COP velocity (control group took longer to achieve postural control) and dynamic acceleration of the pelvis (control group displayed an increase in activity in the pelvis segment) between children with FASD compared to children without PAE during OLS with eyes open. This could be attributed to gender differences and the manner in which the OLS task was performed as the difference was mostly found in male participants, with the task being performed differently between male participants in the case and control groups. The primary challenge for the proposed larger study is revision of how the task is performed to ensure that a larger proportion of trials are eligible for inclusion in the data analysis.