The Physical Fitness and Resilience of 11-13 year old Extremely Low Birth Weight Children.

Marcella Danks (2010). The Physical Fitness and Resilience of 11-13 year old Extremely Low Birth Weight Children. PhD Thesis, School of Rehabilitation Health Sciences, The University of Queensland.

       
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Author Marcella Danks
Thesis Title The Physical Fitness and Resilience of 11-13 year old Extremely Low Birth Weight Children.
School, Centre or Institute School of Rehabilitation Health Sciences
Institution The University of Queensland
Publication date 2010-04
Thesis type PhD Thesis
Supervisor Dr. Yvonne Burns
Dr. Pauline Watter
Total pages 261
Total black and white pages 261
Subjects 11 Medical and Health Sciences
Abstract/Summary ABSTRACT Poor fitness in the able extremely low birth weight (ELBW) population exists alongside deficits in growth, respiratory function, motor ability, learning, socialisation and behaviour. This thesis investigated what physical sequelae of ELBW were persistent and associated with long term problems of fitness, whether there was persistent disparity between able ELBW children and their term born peers in functional outcomes of self perception, competencies and behaviour and assessed the relationship between those outcomes and poor fitness or other mild physical impairments. The predictive validity of early assessment to identify those ELBW children most at risk of poor outcomes long term was investigated. Subjects The 54 ELBW participants (31 male; mean birth weight: 771g, SD147.8g; mean gestational age: 26.6 weeks SD = 2.04 weeks) had a mean age of 12years 6months and the 55 term born comparisons (28 male; at least 37 weeks gestation) had a mean age of 12years 5months. Methods Fitness (VO2 max) was calculated from a 20m Shuttle Run performance. All children completed Motor Assessment Battery for Children (MABC), functional tests of postural stability and strength, respiratory function tests and growth measures. The Harter Self Perception Profile was completed as a measure of self report. Parents completed The Child Behavior Checklist (CBCL). Possible predictors of long term outcome, including birth weight, gestational age, multiple birth status, head circumference and preschool motor assessment scores, were retrieved from records. Procedures Testing was conducted in a single session at a centralised testing centre. Children were tested individually according to set protocols by a trained tester who was blinded as to the child’s group. Results Study I: Fitness in ELBW and term born 11-13year old children. The ELBW group was less fit than the control group with 45% at or below the 10th percentile for V02 max and had poorer functional stability and motor scores. Over 70% of the ELBW group was rated as having a definite motor problem on the MABC. There were differences between the groups on growth, strength and respiratory function. Motor control was the most powerful predictor of V02 max in both the ELBW and the control group. Study II: Parent and child perceptions of aspects of competency and behaviour. Parents of the ELBW group reported less competence and greater behavioural problems in their children but the ELBW children did not differ from their term born peers on self report. On parent report, the ELBW group had less social, school and activity competence with 33.3% of the group scoring within the clinical range on overall competence compared with 9.1% in the comparison group. Parents of the ELBW group reported more social, thought, and attention problem, and more delinquent behaviour in their children than were reported by the parents of the term born children with 14.8% of the ELBW group scoring within the clinical range on overall behaviour compared with 2.3% in the comparison group. Study III: The relationship of fitness and mild motor impairment with competency in ELBW and term born 11-13 year old children. For both the ELBW and the term born children, scholastic competence was associated with motor scores and social competence was associated with both fitness and motor scores, but the association of fitness with successful engagement in activity (rho = 0.567) occurred only in the ELBW group. Fitness and mild motor impairment both had stronger relationship with competencies for the ELBW group than for the term born children as both fitness and motor scores independently predicted CBCL total competence score for the ELBW but not the term born group. The difference between the ELBW and the term groups on CBCL total competence was weakened but persistent when adjusted solely for motor or fitness score but was no longer significant when adjusted for both fitness and motor scores implicating fitness, as well as mild motor impairment, as having independent association with competence measures in ELBW children. Study IV: The relationship of fitness and mild motor impairment with behaviour outcomes in ELBW and term born 11-13 year old children. There was association between fitness and social and attention scores for both groups and association of fitness with the CBCL thought scale for the ELBW group. Motor impairment had association with social and attention problems in all children, but had further association across most of the domains of the CBCL behaviour problem scales in the ELBW children. Motor impairment, but not fitness, independently predicted CBCL overall behaviour score for the ELBW group. Study V: The predictive validity of early motor scores on long term motor outcomes in able ELBW survivors. Early motor assessment, NSMDA score at 4 year old follow-up, independently predicted the MABC scores of the ELBW group at 11-13 years of age. Gestational age, birth weight, multiple birth or head circumference at 4 years did not independently predict long term motor impairment within the ELBW group. 4 year old postural control score rather than neurological score was associated with long term motor outcomes within the able ELBW group at 11-13 years of age. Conclusions Able ELBW 11-13 year old children have poor fitness and deficits in growth, strength, respiratory function, motor ability and postural stability relative to their term born peers. Only the motor impairment score was independently related to fitness for both the ELBW and the term born children. ELBW 11-13 year old children also have poorer competence and behaviour on parent report compared with their term born peers but have comparable sense of their own competence, behaviour conduct and global self worth as their peers. Fitness is related to competence for 11-13 year old ELBW children, independent of its association with motor impairment, with the significant levels of poor fitness in the ELBW group implicated as a barrier to participation. Mild motor impairment is independently related to both competence and behaviour outcomes for 11-13 year old ELBW children. Early motor score, rather than any perinatal measure examined, was the only valid marker of long term motor outcomes within the ELBW group.
Keyword Preterm
ELBW
Fitness
Motor
Competence
Behaviour
Learning
Attention
Social

 
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