|
Brief Summary
|
INTRODUCTION Intellectual disability (ID) is a neurodevelopmental
disorder characterized by 3 features that is deficits in cognition, deficits in
adaptive function, and onset during the developmental period1. Estimates of intellectual disability range between
1–3%, with a male to female ratio of 1.6:1 2. Causes of ID
include genetic abnormalities, as well as prenatal, perinatal, and postnatal
environmental factors3. The summary prevalence of ID
in India was established to be 2% taking into consideration the individual
prevalence studies over the last six decades4. Intellectual disability (ID) is
characterized by significant impairment in cognitive and adaptive behaviour.
The term used to describe this condition has gone under constant change over
the years due to social and political compulsions.
These
children are slow in reaching developmental milestones later than the normal
children. In most individuals with intellectual disabilities, the parts of the
brain continue to develop that is not damaged. Therefore, they continue to
acquire skills and abilities as they grow older. It is often noted that brain
damage causes a delay in development causing skill deficits in some form. When
training support is extended in early years and links are strengthened between
home and school adequately, then training effects sustain for a longer
duration.
Intellectual
disability is not a mental illness. Mental illness can occur at any age whereas
intellectual disability is present from childhood.5 The Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-1V)5 has
classified four different degrees of intellectual disabilities as Mild
intellectual disability (IQ 50–69), Moderate intellectual disability (IQ
35–49), Severe intellectual disability (20–35), Profound intellectual
disability (20–35).6Well-developed fine motor skills facilitate
children’s cognition and attention development and contribute positively to
daily life activities.7
The
American Art Therapy Association (AATA) defines art therapy as a mental health
profession in which clients, facilitated by the art therapist, use artistic
media, the creative process and the resulting artwork to explore their
feelings, reconcile emotional conflicts, foster self-awareness, manage behavior
and addictions, develop social skills, improve orientation in reality, reduce
anxiety and increase self-esteem8. By way of hand-brain
coordination, this therapeutic approach is conducive to maintaining and
developing a patient’s coordination and motor skills and strengthening their
fine motor skills9.
Nonspecific
conventional exercises can be monotonous for the patients, whereas art therapy
can be equally effective and interesting as it encourages patients by creating
varied opportunities that revolve around tasks and activities which help them
improve their hand function10. Theraputty exercise is a form of
finger and grip strength training. It can be formed into various shapes,
providing a well-balanced exercise program. Theraputty delivers a simple and
effective resistance based training which helps to develop a strong, capable
grip11. NEED FOR THE STUDY:
Intellectual disabilities
(ID) in children often present challenges that extend beyond cognitive
functioning, affecting various aspects of their daily lives, including motor
skills and hand function. While interventions targeting hand function are
crucial for enhancing the overall quality of life in these individuals, the
optimal approach remains uncertain.
Two potential
interventions, namely art therapy and grip strengthening exercises, have shown
promise in addressing hand function difficulties in children with intellectual
disabilities. However, a comprehensive and comparative examination of the
effectiveness of these interventions is lacking in current literature.
Art therapy, characterized
by creative expression through artistic mediums, has been proposed as a
therapeutic intervention that may enhance fine motor skills and hand-eye
coordination. On the other hand, grip strengthening exercises, focusing on
physical activities to enhance hand strength and dexterity, have also
demonstrated positive outcomes in various populations.
The need for this study
arises from the lack of clear evidence comparing the efficacy of art therapy
and grip strengthening exercises specifically in children with intellectual
disabilities. Understanding which intervention yields superior outcomes in
terms of hand function will not only contribute to the advancement of
evidence-based practices but also guide healthcare professionals, educators,
and parents in making informed decisions regarding the most effective
intervention for children with intellectual disabilities.
Moreover,
identifying the more effective intervention will have significant implications
for resource allocation and intervention planning, ultimately improving the
overall well-being and functional abilities of children with intellectual
disabilities. This study aims to bridge existing gaps in the literature and
provide valuable insights that can inform clinical practice and contribute to
the optimal care and support of this vulnerable population. RESEARCH QUESTION Is there a difference in the effectiveness of art
therapy and grip strengthening exercises on hand function in children with
intellectual disability? AIM AND OBJECTIVES AIM: To
find the effect of art therapy and grip strengthening exercises on hand function of children
with intellectual disability. OBJECTIVES: 1. To investigate the impact
of art therapy on hand function among children with intellectual disabilities using Bruininks-Oseretsky test - 2, pinch gauge and handheld dynamometer. 2. To find the efficacy of grip strengthening exercises on hand function of
children with intellectual disability using Bruininks-Oseretsky
test - 2,
pinch gauge and handheld dynamometer.
3. To compare the
effectiveness of art therapy and grip strengthening exercises on hand function
of children with intellectual disability Hypotheses Null Hypothesis (H0):
There is
no significant difference in the effect of art therapy and grip strengthening
exercises on hand function in children with intellectual disability. Alternative Hypothesis
(H1):
There is
significant difference in the effect of art therapy and grip strengthening
exercises on hand function in children with intellectual disability. MATERIAL
AND METHODOLOGY Study Setting: Department of Pediatric Physiotherapy, Dr. A.P.J
Abdul Kalam college of physiotherapy, Loni & Special schools around Loni. Study Type: Experimental
study. Study Design: Randomized controlled trial Study Duration: 2 years Sampling Method: Simple Random Sampling
OUTCOME MEASURES Outcome measures used for this study will be as follows,
|
1.
Bruininks-Oseretsky test - 2
(r =0.88)
2.
Hand held Dynamometer (test
retest reliability 0.78-0.85)
3.
Pinch Gauge (r= 0.78-0.82)
ELIGIBLITY CRITERIA: Inclusion criteria: Ø Children with mild and moderate intellectual disability according to
DSM IV criteria. Ø
Aged between 6 to 16 years Ø
Males and females Ø
Children with mean standard
score of < 50 (each subtest) on BOT 2 short form Ø Children with weak grip strength according to age appropriate
normative data. Exclusion criteria: Ø Participants whose parents are not willing to give written informed
consent. Ø Children having musculoskeletal injury of hand since past 6 months
Ø Children having visual or auditory impairments. PROCEDURE Protocol is prepared and ethical clearance will
be obtained from the IEC. The Participants will be selected based on the
eligibility criteria. Informed consent will be obtained from the
caregivers of the participants and demographic data will be recorded. Participants
will be randomly allocated to 3 groups that is experimental group A (n=12),
experimental group B (n=12) and control
group (n= 12). Prior assessment of the participants will be done. Experimental group ‘A’ will be administered with Art
therapy and conventional treatment and group ‘B’ with Grip strengthening training
along with conventional physiotherapy and control group ‘C’ will be
administered with conventional treatment for hand functions. The participants will be given exercise regimen
and administered to perform for 30 mins per session for 3 days in a week for 4
weeks. The hand functions will be measured with Bruininks-Oseretsky
test - 2, Hand held Dynamometer and Pinch Gauge.
Statistical analysis will be done and result will
be calculated. REFERENCES 1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th.
Arlington, VA: American Psychiatric Association; 2013. 2. Leonard H, Wen X. The epidemiology of mental
retardation: challenges and opportunities in the new millennium. Ment Retard Dev Disabil Res Rev. 2002;8(3):117–34 3.
Toth K, deLacy N, King BH. Intellectual disability. In:
Dulcan MK, editor. Dulcan’s textbook of child
and adolescent psychiatry. 2nd 2016. 4.
Russell PSS, Nagaraj S, Vengadavaradan A, Russell S, Mammen
PM, Shankar SR, Viswanathan SA, Earnest R, Chikkala SM, Rebekah G. Prevalence
of intellectual disability in India: A meta-analysis. World J Clin Pediatr.
2022 Mar 9;11(2):206-214. doi: 10.5409/wjcp.v11.i2.206. PMID: 35433303; PMCID:
PMC8985497. 5.
R. Kalgotra, J.S. Warwal.
Intellectual Disability in India: An overview. J. Disability Stud., 2017, 3(1),
1-8. 6.
American Psychiatric
Association. Mental retardation, In Diagnostic and Statistical Manual of Mental
Disorders, 4 th ed., text revision, Washington, DC: American Psychiatric Press,
Inc, 2000. 7.
Pitchford, N. J., Papini, C.,
Outhwaite, L. A. and Gulliford, A. 2016. Fine motor skills predict maths
ability better than they predict reading ability in the early primary school
years. Frontiers in Psychology, 7, 783. 8.
5. American Art Therapy Association.
Definition Statement. 2014.08.20. 9.
Wang Q-Y, Li D-M. Advances in
art therapy for patients with dementia. Chin Nurs Res. 2016;3:105e108.
10.
Hajar R. Art and Healing. Heart
Views 2015;16:116‑7
1.
Wakpaijan KR, Shende M.
Comparative study of two resisted exercise for the improvement of grip strength
in dentist. Int J Multidiscip Res Dev 2017;4:131-6.s
|
|