STUDY ON BIKE RIDING IN DOWNS
AGED 10 OR MORE
AND TREATED BY DRUG THERAPY
By Renato COCCHI a neurologist and a medical
psychologist;
Marco FAVUTO a MD in training
for orthopaedics.
Summary
A group of 82 drug treated Down’s syndrome subjects aged 10 or more
underwent investigation on bike riding with or without support wheels. The
group’s features were: 46 F + 36 M; average age 12.83 + 2.71 years; chromosomal
anomalies: pure trisomy 21 = 75; translocations = 5; mosaicisms = 2. Therapy
lasted average 7.07 years + 2.74, and range 2-12.
The results at last checkup showed that 33 Ss (40%) do not ride a bike,
21 (26%) still use support wheels, and 28 (34%) are free biking. When compared
with the sample of non drug treated Down Ss (Cocchi R., Favuto M.: Ital. J.
Intellect. Impair. 1994, 7: 159-162) this sample significantly differs (<
.05), because more Ss ride a bike, either with support wheels or whithout them.
As for age on which drug treated Downs started biking, it is to be noted
that nobody of them could learn it after 15 years of life. Biking remains a
difficult task for drug treated Down people too and learning it does not
completely match even their better psycho-motor development.
Key words: Down syndrome; drug therapy; byke riding; psycho-motor
development.
Italian translation
Drug modulation of stress reactions
Mental retardation
News
Italian translation
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In our
previous research on bike riding in Down children without drug therapy, we
pointed up: " Biking seems a difficult task for Downs and it appears that
their psycho-motor development does not fully account for it. So we have not
clear which causes this behaviour, and we need to assess other variables, both
psychological and biological.
Since we had
collected the related data, a further investigation on bike riding in drug
treated children could give some light on it. To better understand this complex
problem, we decide to study how ride a bike the Downs aged 10 or more, who took
drug therapy for at least two years.
Materials and method
From 525
records of Down subjects, we checked up those about subjects aged 10 or more at
last consultation after at least two years drug therapy. We collected then
information on age at last consultation, sex, chromosomal diagnosis, and the
use of a bike, from the singled out records.
If such a
use had started before, we noted the year the child got to it. For this study a
year of life encompasses 6 months before birthday and 6 months after it (Eg.
The 11th year ranges from 10 years 7 months to 11 years 6 months).
In a similar way we counted up the length of a therapy (Eg. Two years therapy
ranges from one year 7 months to 2 years 6 months).
As for
bike riding, we summed up this behaviour by seeing about if the child uses a
bike, and if yes, whether he has left behind support wheels. We counted in two
ways: first we referred them to the total of the sample. Then, we split the
sample up into three sub-samples according to years’ ranges such as 10-12,
13-15, 16 or more years.
Statistics:
Chi Square, when suitable.
Results
We
present the results we have obtained as it follows. Eighty and two out of 525
records (15.62%) matched the study criteria and made the sample up. Table 1 shows
epidemiological data of the sample and sub-samples 1-3. Tables 2 checks up bike
riding and in table 3 we made a comparison with the data of our previous
research on this topic (Cocchi & Favuto, 1994). Table 4 shows the age the
investigated Downs started to ride a bike.
Table 1:
epidemiological data and years of therapy of the sample and 10-12, 13-15, 16 or
more years sub-samples.
|
|
Sample |
Sub-samp.1 |
Sub-samp.2 |
Sub-samp.3 |
|
No. of Ss |
82 |
50 |
22 |
10 |
|
" " F |
46 |
27 |
15 |
4 |
|
" " M |
36 |
23 |
7 |
6 |
|
F/M *100 |
128/100 |
117/100 |
214/100 |
43/100 |
|
Chromosomal anomalies |
|
|
|
|
|
Ss with stand. trisomy 21 |
75 = 91.46% |
46 = 92.0% |
21 = 95.5% |
9 = 90.0% |
|
Ss with translocations |
5 = 6.10% |
4 = 8.0% |
0 |
0 |
|
Ss with mosaicisms |
2 = 2.44% |
0 |
1 = 4.5% |
1 = 10.0% |
|
Average age (years) +/- SD |
12.83 +/- 2.71 |
11.08 +/- 0.83 |
14.23 +/- 0.87 |
18.50 +/-1.72 |
|
Aver.yrs of therapy +/- SD |
7.07 +/- 2.74 |
6.84 +/- 2.66 |
7.41 +/- 3.16 |
7.50 +/- 2.27 |
|
Range (years) |
2-12 |
2-11 |
3-12 |
3-10 |
Table 1 shows the prevalence of females on males, in the sample and in
10-12 and 13-15 sub-samples, but a strong reverse in 16 and more years sample. The
distribution of chromosomal anomalies of the sample is normal, those of 10-12
and 13-15 samples are fairly correct, but this is not true for 16 or more years
sample. Averages of years of therapy differ very little.
Table
2: Down aged 10 years or more and bike riding; total sample and 10-12, 13-15,
16 or more years sub-samples as recorded at last checkup.
|
Behaviour |
Sample |
Sub-samp.1 |
Sub-samp.2 |
Sub-samp.3 |
|
|
Ss no. + % |
Ss no. + % |
Ss no. + % |
Ss no + % |
|
Biking w/ support wheels |
21 = 25.61% |
18 = 28.00% |
7 = 31.82% |
0 |
|
Free biking |
28 = 34.15% |
18 = 36.00% |
7 = 31.83% |
3 = 30.00% |
|
Sub-totals |
49 = 59.76% |
32 = 64.00% |
14 = 63.63% |
3 = 30.00% |
|
Refuses biking |
33 = 40.24% |
18* = 36.00% |
8 = 36.27% |
7* = 70.00% |
|
Totals |
82 = 100% |
50 = 100% |
22 = 100% |
10 = 100% |
(*) In past 2 + 1 subjects rode with support wheels.
Table 2 shows that nearly 60% of the sample currently ride a bike.
Table 3: comparison
between non drug treated Downs (NDTD: data from Cocchi & Favuto, 1994) and
drug treated Downs (DTD).
|
Behaviour / |
Sample |
Sub-samp.1 |
Sub-samp.2 |
Sub-samp.3 |
||||
|
No. of Ss |
NDTD |
DTD |
NDTD |
DTD |
NDTD |
DTD |
NDTD |
DTD |
|
W/ supp. Wheels |
16# |
21 |
12 |
14 |
3 |
7 |
0 |
0 |
|
Free biking |
26@ |
28 |
14 |
18 |
5 |
7 |
4 |
3 |
|
Refuses biking |
50$ |
33 |
28 |
18 |
17 |
8 |
12 |
7 |
Chi Square, with 2 df (only for the sample): 6.192, and p < .05.
NB We split the 7 cases found as "non investigated" in our
previous paper into the NDTD sample, as it follows: # = 1 case added; @ = 2
cases added; $ = 4 cases adedd.
While refusers make up the majority of the sample and sub-samples people
among NDTD, the contrary happens for DTD, save 16 and more years sub-sample.
Table 4: Age of starting to ride a bike in Downs aged 10 years or more,
treated by drug therapy.
|
Behaviour |
Bef. 10 yrs |
10-12 yrs |
13-15 yrs |
16+ years |
|
|
Ss no. + % |
Ss no. + % |
Ss no. + % |
Ss no + % |
|
With support wheels |
7 = 8.54% |
13 = 15.85% |
1 = 1.21% |
0 |
|
Free biking |
9 = 10.98% |
14 = 17.08% |
5 = 6.09% |
0 |
|
Sub-totals |
16 = 19.52% |
27 = 32.93% |
6 = 7.30% |
0 |
|
Refuses biking |
|
18 = 31.95% |
8 = 9.76% |
7 = 8.54% |
|
Totals |
16 = 19.52% |
45 = 54.88% |
14 = 17.06% |
7 = 8.54% |
As we can see, in this sample nobody could learn biking after 15 years.
Discussion
Although a sample of 82 Down subjects out of 525 had to be representative,
the F/M ratio differs very much from about 100/135 expected. On the other hand,
the distribution of the chromosomal anomalies of the sample matches the Italian
and International distributions. In sub-samples this distribution fails to do it.
Presently we do not know if gender proportion and chromosomal anomalies
distribution are crucial for this study too. Therefore, we cannot think out the
sample as representative, and we retain ourselves to generalize the results.
Nevertheless, by its features the present sample matches better the sample of
NDTD we investigated in our previous paper (Cocchi & Favuto, 1994) An
overview to the Table 2 shows immediately that nearly 60% of the subjects of
this sample currently ride a bike. As we wrote in our previour research, this
rate is far from the evidence of nearly 100% of same age normal subjects
enjoying bike riding, at least in Italy.
Sub-samples present an increased bike riding in age 10-12 but a deacrese
in following ages. If not due to a bias, we can think that drug therapy could
drive to a wider learning of the bike’s use.
We have to note that sub-samples 1 and 3 include among present refusers
3 boys who have left their skill in bike riding.
One of us early described this fact as a part of reduced motor
performances in 3 adults Down with mixed demential and pseudodemential
problems. (Cocchi & Cordella, 1990)
We noted two cases also in our previous paper on non drug treated Downs
(Cocchi & Favuto, 1994). We can think it as a signal of reduced psychomotor
skills, by the years going on.
Although less than in NDTD, the number of Downs unable to leave support
wheels always appears very high when compared to what same age normal children
usually do.
We can speculat on this kind of result, but it seems not easy to give a
clear answer.
We need to confirm here our previous suggestion. Surely we had found
fearful parents, or others who scarcely had insisted on their child riding a
bike, but undoubtedly we have seen also many Down children showing unreasonable
refusal, specially when parents urged them to leave the support wheels.
Some Down children fear losing their own balance control, but balance
problems do not clearly look as true difficulties when we consider the actual
psycho-motor development of the child. To put their feet in a little surface,
like pedals are, seems evoke a feeling of being firmless, a kind of empty fear.
This suggestion comes only from us because we did not find any Down child who
could say why he refused to ride a bike.
Table 4 gives some new information. Fifteen years of age appear a limit
in learning to ride a bike in Downs. Iida and coll., 1993 confirmed that 15
years as the age limit for brain plasticity both in normals and even more in
Down. Perhaps such a behaviour goes along with this biological event.
Conclusion
The study of biking in a sample of 82 drug treated Down subjects aged 10
years or more showed that about 60% is currently riding a bike. As compared to
a sample of non drug treated Down, we found biking increased in a significant
degree.
While most non drug treated Downs refused bike riding, in drug treated
Downs biking hade become the prevalent behaviour. Among bike riders, nearly 43%
did non leave the support wheels, about the same rate we noted in non drug
treated Downs.
As we reported for age of walking (Cocchi, 1989) and motor development
(Cocchi & Favuto, 1993), drug therapy could account for an increased number
of Downs who ride a bike. Nevertheless this complex problem deserves further
investigation, and we only hope to have brought some light on it.
References
Cocchi R.: The anticipation of walking in drug treated Down infants: A controlled study. Ital. J. Intellect. Impair. 1989, 2: 15-19. Cocchi R., Cordella L.: Evoluzione demenziale in soggetti Down: 3 casi clinici. Atti del III congresso nazionale SIPG. Idelson, Napoli 1990.
Cocchi R., Favuto M.:
Miglioramenti motori dopo 3-8 mesi di trattamento con farmaci, nei Down. Riv. Ital.
Disturbo Intellet. 1993, 6: 251-258. Cocchi R., Favuto M.: Study of bike riding
in Downs of 10 years or more. It. J. Intellect. Impair. 1994, 7: 159-162.
Iida K., Takashima S., Mito T., Yao R., Onodera K.: Immuno- istochemical
and Golgi studies on brain development and aging in patients with Down
syndrome. It. J. Intellect. Impair. 1993, 6: 3-11.
Paper presented during the 6th World Down Syndrome Congress, Madrid October 1997
Printed on It. J. Intellect Impair. 1995, 8: 31-36
Author’s address: dr. Renato COCCHI, via Rabbeno, 3
42100
Reggio Emilia (Italy)
renatococchi@libero.it
Down's
syndrome
Drug
modulation of stress reactions
Mental
retardation
News
Italian translation
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