COMPARISON ON BALANCE DEVELOPMENT IN DOWNS AGED FROM 13-24 TO 61-72
MONTHS, NOT PRETREATED AND PRETREATED WITH ANTISTRESS DRUG THERAPY
Renato
COCCHI, neurologist and medical psychologist.
Summary.
Two
groups of Down Ss with age between 13 and 72 months at the first consultation
had evaluation for the balance after at least 6 months they reached walking and
revalued one year lated, during the antistress drug therapy.
At the
first consultation, the group of the subjects not pretreated before they
started walking was 120 but 92 one year later, with average age: initial 42.56
months, and 42.13 for who coming to check. There was reduced male prevalence at
the first consultation, female prevalence at the checkup, with normal
distribution of the chromosomal anomalies.
The
group of the pretreated subjects before they started walking was 49 at the
first evaluation but 47 at the checkup, with average age 11.98 months and 12.07
for whom coming to check. Female prevalence was the same both in the first
examination that to the checkup, with normal distribution of the chromosomal
anomalies.
The
investigation has suggested that the balance improvement seems different when
drug therapy started before walking or after it. In this age range pretreated
subjects seem reaching anticipate more stable balance conditions.
Key
words: Down syndrome, balance, stress, age, drug therapy.
Drug
modulation of stress reactions
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In a
preliminary note on the balance troubles in Down children (Cocchi, 1991) a
neurophysiological, neuropatological, clinical and rehabilitative frame of
reference where these troubles take room and their treatment possibilities. In
that moment, I pointed up the dysfunctionality of vestibular, midbrain-pontine
and cerebellar areas as possible causes inducing balance deficits.
Materaials and method.
This investigation
used the clinical clinical records referring to 383 home reared and home living
Downs as seen in outpatients' clinic by the present author, and object of the
first investigation on the balance. (Cocchi, 2003).
I
selected the clinical records of the subjects aged between 13 and 72 months at
the first visit, non-being or being treated for a maximum of five months before
walking ( the group of not pretreated Ss) and the clinical records of the
subjects treated for at least six months before walking ( the group of
pretreated Ss ).
Such
clinical records had to have the record of the balance checkup after one year
during an antistress drug therapy.
From
those clinical records I collected:
- sex;
-
chromosomal diagnosis;
- age at
1st consultation;
- age of
the walking, if attained before the first examination, or before six months
from the drugs taking (Group of not-pretreated Ss);
- age of
the walking when attained after at least six months of drugs taking (Group of
pretreated Ss);
- balance
scoring after one year of drugs taking;
- the
gradation of the balance as prevailing aspects, as it follows.
I must
remember that a child may anticipate a symptom of the upgrading condition,
(usually the biking without support wheels) or may maintain a symptom of the
downgrading condition (fear to be upon the basis of the scale to weigh).
(++++) a
little uncertain walking; enlarged maintenance base; going upstairs downstairs
by a simple footstep with the support of the adult or of the handrail; the
child doesn't run, nor jumps, and he/she goes in panic if standing upon the
basis of the scale to measure his/her weighs;
(+++)
sure walking; less enlarged maintenance base; he/she climbs by alternating feet
and go downstairs by simple footstep, without any support; awkward run; he/she
doesn't know how to jump; and he/she goes in panic if standing upon the basis
of the scale to measure his/her weigh;
(++)
normal run or just a little awkward, with wavering of limbs; going upstairs and
downstairs with alternating feet; jumps from at least two steps; he/she is
biking with support wheels; no panic when he/she stands upon the basis of the
scale to measure his/her weigh;
(+) like
the preceding grade (++) but, as more, he/she is biking without support wheels.
The balance trouble is nearly absent.
I
elaborated the collected data by plain statistics and I compared the two groups
by 12-months-step age bands, and I evaluated them, when possible, with the Chi
Square test.
Results.
In the
tables that follow, I reported the data of 120 + 92 subjects not pretreated,
and of 49 + 47 subjects pretreated both with initial and final balance scoring,
according to the clinical cards used for this investigation.
Table 1.
Distribution for gender, chromosomal diagnosis and age of the subjects where
the balance had scoring or at the first consultation, if they were already
walking since more than six months (not pretreated Ss), or 6-7 months after
they started walking, if seen for the first time before walking, and
immediately having drug therapy (pretreated Ss).
|
|
Not pretreated Ss |
Pretreated Ss |
||||||
|
|
Initial |
Final |
Initial |
Final |
||||
|
Balance scoring |
Ss Nu. |
% |
Ss Nu. |
% |
Ss Nu. |
% |
Ss Nu. |
% |
|
Males |
65 |
54.17 |
41 |
44.57 |
24 |
48.98 |
20 |
42.55 |
|
Females |
55 |
45.83 |
51 |
55.43 |
25 |
51.02 |
27 |
74.07 |
|
Ratio M/F.100 |
118.18 |
80.39 |
96.00 |
74.07 |
||||
|
Chromosomal dignoses |
|
|
|
|
|
|
|
|
|
Standard trisomy 21 |
112 |
93.33 |
86 |
93.48 |
46 |
93.88 |
44 |
93.62 |
|
Translocationsi |
4 |
3.33 |
3 |
3.26 |
2 |
4.08 |
2 |
4.25 |
|
Mosaicisms |
3 |
2.51 |
3 |
3.26 |
1 |
3.26 |
1 |
2.13 |
|
Only clinical diagnosis |
1 |
0.83 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
Age at 1st visit. |
|
|
|
|
|
|
|
|
|
Average +/- SD (months) |
42.56 +/- 14.86 |
42.42+/-16.69 |
11.98 +/- 4.99 |
12.07 +/- 5.05 |
||||
|
Range (months) |
12-72 |
12-72 |
6-33 |
6-33 |
||||
The
scored data has the usual male prevalence, although reduced, only in the group of
not pretreated Ss at the first consultation. At the final scoring of both
groups, and at the initial scoring of the pretreated Ss, there is instead
female prevalence, which increased in the final scoring of pretreated Ss.
The
distribution of the chromosomal anomalies does not really differ from what
known for Italian and international Down population.
The
average age difference, at the first and at the final consultation, has scarce
relevance for both Ss groups (not pretreated or pretreated Ss).
Table 2.
Subjects not previously drug treated. Distribution for age bands of the balance
trouble at the first consultation, in months and with one year step, as scored
at six or more months after walking, and 12 months after, during drug therapy.
|
Total of Ss --> |
120 Ss = 100.00 %, with
initial scoring 92 Ss of them = 76.67 with scoring after one year |
|||||||
|
|
||||||||
|
Age, in months |
Grade ++++ Nu.of Ss |
% |
Grade +++ Nu.of Ss |
% |
Grade ++ Nu.of Ss |
% |
Grade + Nu.of Ss |
% |
|
13-24 initial |
8 |
6.67 |
1 |
0.83 |
0 |
0.00 |
0 |
0.00 |
|
13-24 final |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
25-36 initial |
22 |
18.33 |
11 |
9.17 |
2 |
1.67 |
0 |
0.00 |
|
25-36 final |
0 |
0.00 |
8 |
6.67 |
1 |
0.83 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
37-48 initial |
9 |
7.50 |
13 |
10.83 |
3 |
2.50 |
0 |
0.00 |
|
37-48 final |
0 |
0.00 |
16 |
13.34 |
21 |
17.5 |
1 |
0.83 |
|
|
|
|
|
|
|
|
|
|
|
49-60 initial |
6 |
5.00 |
19 |
15.83 |
5 |
4.17 |
0 |
0.00 |
|
49-60 final |
0 |
0.00 |
10 |
8.33 |
7 |
5.83 |
1 |
0.83 |
|
|
|
|
|
|
|
|
|
|
|
61-72 initial |
3 |
2.50 |
18 |
15.00 |
2 |
1.67 |
0 |
0.00 |
|
61-72 final |
1 |
0.83 |
9 |
7.50 |
16 |
13.33 |
1 |
0.83 |
|
|
|
|
|
|
|
|
|
|
|
Totals of iniz. 120 Ss |
40 |
33.33 |
68 |
56.67 |
12 |
10.00 |
0 |
0.00 |
|
Totals of fin. 92 Ss |
1 |
0.83 |
43 |
35.83 |
45 |
37.5 |
3 |
2.50 |
Graph 1
How we
may see from the graph 1, in not pretreated Ss from 1-2 to 5-6 years, the worst
balance condition sinks nearly to 0 at 6 years. It is possible that the
rehabilitative treatments put into play have a very important role.
Graph 2
In spite
of rehabilitative treatments, at 6 years 7.5% have still remarkable problems,
in these not drug pretreated Ss.
Graph 3
The
condition of reduced balance troubles, at 6 years relates to 13.33% of not drug
pretreated Ss.
Table 3.
Pretreated Ss. Distribution of the balance troubles for age bands at the first
examination, till 60 months, as scored 6-7 months after walking in Ss already
in drugs treatment, and 12 months later.
|
Total of Ss --> |
49 Ss = 100.00%, with
initial scoring; 47 Ss of them = 95.92% with final scoring, after one year |
|||||||||
|
|
N u. o f S s |
|||||||||
|
Age, in months |
13-24 |
% |
25-36 |
% |
37-48 |
% |
49-60 |
% |
61-72 |
% |
|
++++ initial |
2 |
4.08 |
26 |
57.14 |
4 |
8.16 |
1 |
2.04 |
0 |
0.00 |
|
++++ final |
0 |
0.00 |
1 |
2.04 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
+++ initial |
1 |
2.04 |
12 |
24.49 |
1 |
2.04 |
0 |
0.00 |
0 |
0.00 |
|
+++ final |
0 |
0.00 |
0 |
0.00 |
30 |
61.22 |
4 |
8.16 |
2 |
4.08 |
|
|
|
|
|
|
|
|
|
|
|
|
|
++ initial |
0 |
0.00 |
0 |
0.00 |
2 |
4.08 |
0 |
0.00 |
0 |
0.00 |
|
++ final |
0 |
0.00 |
1 |
|
8 |
16.33 |
0 |
0.00 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
+ initial |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
|
+ final |
0 |
0.00 |
0 |
0.00 |
0 |
0.00 |
1 |
2.04 |
0 |
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Totals inizial 49 Ss |
3 |
6.12 |
38 |
77.55 |
7 |
14.29 |
1 |
2.04 |
0 |
0.00 |
|
Totals final 47 Ss |
0 |
0.00 |
2 |
4.08 |
36 |
77.55 |
5 |
10.20 |
2 |
4.08 |
This
table is the same already published previously under the name of Tab. 6 (Cocchi
2003).
After one
year, there is a clear displacement of pretreated Ss for at least six months before
walking, towards a balance condition with a lighter deficit (degree ++).
To that
it has to add one subject with quite normal balance (degree +), after one year
of drug treatment.
Graph 4:
At six
years age the reduction of the worst balance condition reduced nearly to zero,
in subjects treated even with drugs.
Graph 5
At five years,
in subject pretreated with drugs, even the condition with remarkable balance
problems already reduced to the 8.16%.
Graph 6
At 5
years, in drugs pretreated Ss, even the condition with moderate balance
troubles reduced to zero.
Tab. 4:
Comparison between not pretreated and pretreated Ss as for the severity of the
balance trouble.
|
Age band (months) |
++++ |
++++ |
+++ |
+++ |
++ |
++ |
||||||
|
Not pretreat. |
Pretreated |
Not pretreat. |
Pretreated |
Not pretreat. |
Pretreated |
|||||||
|
Scoring. --> |
Initial |
Final |
Initial |
Final |
Initial |
Final |
Initial |
Fineal |
Initial |
Final |
Initial |
Final |
|
|
Rates -----> |
|||||||||||
|
13-24 |
6.67 |
0.00 |
4.08 |
0.00 |
0.83 |
0.00 |
2.04 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
|
|
||||||||||||
|
25-36 |
18.33 |
0.00 |
57.14 |
2.04 |
9.17 |
6.67 |
24.49 |
0.00 |
1.67 |
0.83 |
0.00 |
2.04 |
|
|
||||||||||||
|
37-48 |
7.50 |
0.00 |
8.16 |
0.00 |
10.83 |
13.34 |
2.04 |
61.22 |
2.50 |
17.50 |
4.08 |
16.33 |
|
|
||||||||||||
|
49-60 |
5.00 |
0.00 |
2.04 |
0.00 |
15.83 |
8.33 |
0.00 |
8.16 |
4.17 |
5.83 |
0.00 |
0.00 |
|
|
||||||||||||
|
61-72 |
2.50 |
0.83 |
0.00 |
0.00 |
15.00 |
7.50 |
0.00 |
4.08 |
1.67 |
13.33 |
0.00 |
0.00 |
|
|
||||||||||||
|
Totali |
35.00 |
0.83 |
71.42 |
2.04 |
49.80 |
35.83 |
28.57 |
73.46 |
10.01 |
37.49 |
4.08 |
18.37 |
For the Chi Square calculation: 0 = 0.01
++++ Initial vs final treatment of: not pretreated Ss: Chi Square =
9.043 with 4 df and p = 0.060 NS.
++++ Initial vs final treatment of: pretreated Ss: Chi Square = 0.602
with 4 df and p = 0.963 NS.
++++ Initial: Not pretreated vs pretreated: Chi Square = 16.795 with 4
df and p = 0.002;
++++ Final: Not pretreated vs pretreated: Chi Square = 2.782 with 4 df
and p = 0.595 NS.
+++ Initial vs final treatment of: not pretreated Ss: Chi Square = 3.545
with 4 df and p = 0.471 NS.
+++ Initial vs final treatment of: pretreated Ss: Chi Square = 91.735
with 4 df and p = 0.0009:
+++ Initial: Not pretreated vs pretreated: Chi Square = 41.014 with 4 df
and p = 0.0009;
+++ Final: Not pretreated vs pretreated: Chi Square = 28.867 with 4 df
and p = 0.0009;
++ Initial vs final treatment of: not pretreated Ss: Chi Square = 7.483
with 4 df and p = 0.112;
++ Initial vs final treatment of: pretreated Ss: Chi Square = 6.043 with
4 df and p = 0.196 NS.
++ Initial: Not pretreated vs pretreated: Chi Square = 6.463 with 4 df
and p = 0.167 NS.
++ Final: Not pretreated vs pretreated: Chi Square = 14.859 with 4 df
and p = 0.005.
In spite
of the difficulty of calculus for the presence of too much blank values, I
found five significantly different comparisons, and at least one of them for
every degree of severity.
Although
we need to suppose that the group of not previously treated Ss has bias because
the first balance scoring happened more than 6-7 months after walking, we may
however observe that the following distributions significantly diverged:
- grade ++++, not preteatedi vs. pretreated initial rate;
- grade +++, pretreated, initial and final rate ;
- grade +++, not pretreated vs pretreated initial rate;
- grade +++, not pretreated vs pretreated final rate;
- grade ++, not pretreated vs pretreated final rate.
The +++
degree of severity is undoubtedly that with increasing modifications.
Graph 7
Although
having a greater rate (2.04% vs 0.83%), after one-year therapy, the pretreated
Ss belong to a lower age band.
Graph 8
At six years
the results are practically overwhelming, with a light prevalence of the
diminution of the pretreated subjects ( 4.08% vs 7.50%).
Graph 9
At six
years, in the pretreated Ss there is a sound reduction even of the less
precarious condition (0.00% vs 13.33%).
Tab. 5:
Comparison among % variations after therapy in not pretreated and pretreated Ss
as for the severity of the symptom.
|
Age band (months) |
++++ |
++++ |
+++ |
+++ |
++ |
++ |
||||||
|
Not preatrat. |
Pretreated |
Not pretreat. |
Pretreated |
Not preatrat. |
Pretreated |
|||||||
|
Scoring--> |
Initial |
Final |
Initial |
Final |
Initial |
Final |
Initial |
Final |
Initial |
Final |
Initial |
Fina |
|
|
Rates -----> |
|||||||||||
|
Totals |
35.00 |
0.83 |
71.42 |
2.04 |
49.80 |
35.83 |
28.57 |
73.46 |
10.01 |
37.49 |
4.08 |
18.37 |
|
% Variation |
- 97.63 |
- 97.14 |
- 28.06 |
+ 257.12 |
+ 374.52 |
+ 450.25 |
||||||
Even now,
it is not easy to give a clean judgment. We may observe that the not pretreated
Ss go on to lower till the +++ degree, the pretreated instead, lower of the
same percentage in the ++++ degree, but they increase from the +++ degree. In
the ++ degree, both groups are rising, even if with different rates.
It seems
however that we can conclude that pretreated Ss more easily arive to a more
stable balance development.
Discussion.
I repeat here
that it is not easy to find literature on specific investigations of the
balance troubles in the Downs. Internet (Google) and Medline from the 1960 to
today did not give any help. For what I know, doesn't exist research on balance
results in drugs treated Downs.
My
previous epidemiological survey was nearly certainly the first wide casuistry,
evaluated either for the chronological age at the first examination, either
according to walking age (Cocchi, 2003 ).
The
second investigation on the effects on the balance of an antistress drug
therapy (for the drugs used and their dosages, see: Cocchi, 1993 and Cocchi
2003 ) has pointed on that in both groups under observation (not pretreated and
pretreated Down Ss) the course of the positive response does not parallel the
normal balance course of same age Ss before the the drug treatment.
I found
an acceleration towards conditions of greater stability, a few fact debatable
fact, mainly in the non pretreated group at first evaluation (Cocchi, 2003).
In this
third research, it is to remember that the group of the not pretreated Ss, to
difference of the pretreated Ss, were often scored initially to much more than
6-7 months from the walking acquisition, so with greater acquired experience.
In spite of this bias, after one year of drugs therapy, the pretreated's
balance seems evolving more easily towards greater stability, as visible in the
results of the degree +++.
It is
incomprehensible, by now, the fact that at the checkups after one year drug
therapy in both groups, and at the initial scoring, in the group of the
pretreated Ss, there is a female prevalence.
Conclusion.
The
investigation on the balance troubles in Downs aged from 1-2 to 5-6 years
treated with an antistress drug therapy, at the checkup after one year, showed
that the balance development could be different if drug therapy started before
or after walking.
In that
age range the pretreated Down Ss seem reaching more stable balance conditions
in advance.
References.
Cocchi
R. Evaluation of balance in Down persons. An epidemiological and clinical
investigation on 383 subjects. 2003 <www.stress-cocchi.net/Down35.htm>
Cocchi R.
The balance in 230 Down subjects. An evaluation after one-year antistress drug
therapies. 2003 <www.stress-cocchi.net/Down36.htm>
Posted on Internet on
December 2003. Copyright by Renato Cocchi, 2003.
Author’s address: Dr Renato COCCHI, via
Mercalli 10
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Drug
modulation of stress reactions
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