It appears you don`t have a PDF plugin for this browser. No biggie
Transkrypt
It appears you don`t have a PDF plugin for this browser. No biggie
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.3/2014 (25-29) ● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.3/2014 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ●● ● 25 The identification of postural defects in preschool children (Identyfikacja wad postawy u dzieci w wieku przedszkolnym) M Grzegorczyk 1,A,D,E,F, B Mroczek 1,B, W Grzegorczyk 2,C, B Karakiewicz 1,B Abstract - Introduction: The changes in the physical development of children occurring between 3 and 6 years of age are characterised by an increased exercise capacity of the whole body and its various organs. Bad habits and low activity may be the cause of irregularities in body posture. Aim of the study: The identification of postural defects in preschool children. Material and methods: The examination was carried out in a group of 50 preschool children from a private nursery (52%, 26) and a state nursery (48%, 24), aged 3-6 years (mean age 4.5 ± 0.9 years). Results: In the group from the state nursery, there were 12 (50.0%) children with a tendency to valgus foot. In the group of children from the private nursery, there were 5 (29.2%) cases of this defect. In the group from the state school, this irregularity occurred significantly more often (Chi2 = 5.27, p = 0.0218). Other studies show certain differences, yet statistically insignificant. Conclusions: There is a need for the early monitoring of the correct posture of children at this stage of development when their osteo-musculo-articular system changes. Wnioski: Istnieje potrzeba wczesnego monitorowania prawidłowej postawy ciała dzieci w tej fazie rozwoju, kiedy ich układ kostno- mięśniowo- stawowy podlega zmianom rozwojowym. Słowa kluczowe - stopa płasko-koślawa, postawa ciała, wady postawy. Author Affiliations: 1. The Department of Public Health at the Pomeranian Medical University of Szczecin 2. Social Insurance Institution in Szczecin Authors’ contributions to the article: A. The idea and the planning of the study B. Gathering and listing data C. The data analysis and interpretation D. Writing the article E. Critical review of the article F. Final approval of the article Key words - valgus flat foot, body posture, postural defects. Streszczenie – Wstęp: Zachodzące w rozwoju fizycznym dziecka zmiany między 3 a 6 rokiem życia charakteryzują się zwiększona wydolnością całego organizmu oraz poszczególnych jego organów. Złe nawyki, niewielka aktywność mogą być przyczyna powstawania nieprawidłowości w postawie ciała. Cel pracy: Identyfikacja wad postawy u dzieci w wieku przedszkolnym. Materiał i metody: Badanie przesiewowe postawy ciała przeprowadzono w grupie 50 dzieci przedszkolnych z przedszkola niepublicznego (52%, 26) i publicznego (48%, 24), w wieku 36 lat, średnia wieku 4,5±0,9 lat. Wyniki: W grupie dzieci z przedszkola publicznego 50% (12) było z tendencją do koślawienia stóp, a w grupie dzieci z przedszkola prywatnego 29.2% (5) dzieci. W grupie dzieci z przedszkola publicznego ta nieprawidłowość występowała istotnie częściej(wartość testu Chi2=5,27,p=0,0218). Pozostałe wyniki badań wykazują pewne różnice, ale statystycznie nieistotne. Correspondence to: Maria Grzegorczyk Department of Public Health, Pomeranian Medical University in Szczecin, Zabużańska 35a Str., Pl-71051 Szczecin,e-mail: [email protected] Accepted for publication: July18,2014. I. INTRODUCTION he preschool period is the period of a child’s development between 3 to 6-7 years of age and it precedes the compulsory school age. Most children go to nurseries at that time and they are subject to the educational system [1]. The influence of this system is related to instruction, shaping positive emotional and social attitudes but also to the psychophysical and motor develop- T ● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.3/2014 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● ment. The changes in the physical development of a child occurring between 3 and 6-7 years of age are characterised by an increased exercise capacity of the whole body and its various systems [2-5]. Participation in preschool activities provides the necessary conditions for the need of children to move related to their development, through the fulfilment of physical activity programme tasks whose purpose is to promote a good health, appearance, manner of movement, and shape a proper body posture [2]. It is a time when children develop their skills and abilities, when the physical appearance is moulded, body proportions change, the process of growth becomes intensified and motor features are shaped [6]. Bad habits and low activity may be the cause of irregularities in body posture, scoliosis or dysfunctions and defects of the lower limbs and feet. The early detection of irregularities in body posture may prevent the child from developing them further and it guarantees effective treatment. A postural defect recognised too late becomes permanent, which may have serious consequences in adulthood. Childhood is undoubtedly the best period for the prevention of postural defects and the promotion of a healthy behaviour. One of the main factors preventing the development of postural defects in this period is spontaneous movement and the natural need of preschool children to move. Therefore, natural forms of activity must be fostered and the development of motor characteristics must be modulated. Tasks in this scope should be fulfilled in the nursery with the active participation of parents. Low, purpose-oriented physical activity and passive forms of spending free time increase the probability of developing postural defects, which are common in preschool children. [6] Body posture is a person’s individual feature. It changes depending on age, health condition, eating habits and lifestyle [7]. Changes in the body posture of a preschool child are slow; in the preschool period from 4 to 7 years of age, the posture tends towards deepening lumbar lordosis, the angle of the anterior pelvic tilt increases and the stomach flattens. From 4 years of age, the fad pads which were in the flat, weak and poorly arched feet of a three-year-old, begin to disappear. The concavity of the sole becomes apparent, in a five-year-old the foot becomes visibly longer, and a six-year-old child already has distinct longitudinal and transverse arches. The assessment of proper foot shape is of crucial importance in terms of prevention and correction of potential deformations [8]. A proper shaping of spine curves in the sagittal and coronal plane, a proper tension of postural muscles, and the nervous system in charge of it all, help to maintain a 26 healthy posture [9]. The following features characterise a proper standing position: a straight head position, level shoulders, shoulder blades pulled back, a symmetrical position of the pelvis (level iliac spines), a slight protrusion of the stomach, a proper arch of the feet and proper weight distribution on feet [10]. An improper body posture occurs when the shape of the body resulting from the structure and habitual position of particular parts of the body is not beneficial to the body as a whole. A considerable protrusion of the stomach, a rounded back, a winging of the scapula, shoulders and head pulled forward are indicative of an improper posture [11]. Deviations from the generally accepted features of a healthy posture are described in the literature of the subject as postural defects – they may deepen as the child grows and develops due to insufficient movement and lacking prevention [12]. The aim of the study was to identify postural defects in preschool children. II. MATERIALS AND METHODS The assessment of body posture was conducted in a group of 50 children aged 3-6 from randomly selected nurseries. In the examined group, 52% (26) children were from a private nursery and 48% (24) from a state nursery. In the assessed group, there were 56% (28) boys and 44% (22) girls. The average age of children from the state nursery was 4.0±0.1 (range of 4.0-4.5 years), and from the private nursery - 4,5±0,9 years (range of 3,0-6,0 years). Children from the private nursery were older than children from the state nursery (Z=2.00, p=0.04). It was found that children from the state nursery stayed longer in the nursery during the day than children from the private nursery (Z=3.11, p=0.01), they also spent more time outdoors during the day (Z=3.58, p=0.001), and they spent much more time outdoors during the week (Z=2.19,p=0.03). Children from the private nursery watched TV longer than children from the state nursery (Z=-5.99, p=0.0001). The data have been presented in table 1. The study plan covered a careful observation of the children in a relaxed standing position, without shoes on, only in underwear. The examination proper consisted of a visual assessment of posture from the front, back, side and top in a forward-bending position as well as of the position of knees, the foot arch bearing and not bearing body weight while standing on both feet, one foot and while walking. All children were examined for body weight and height, using medical scales, and also the BMI (Body Mass Index) was calculated. When assessing ● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.3/2014 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● the position of the body in the coronal plane from the front and back, attention was paid to the position of the head, level position of the shoulders and shoulder blades as well as the course of the spinous processes, the shape and symmetry of waist triangles, the position of the knees and feet. The plane started from the occipital protuberance and it went across: the line of iliac spines, the intergluteal cleft and to the floor in the place where feet touched each other. When assessing body posture in the sagittal plane, it started from the level of the mastoid process of the temporal bone, it went across the centre of the shoulder joint, the greater trochanter of the femur, somewhat to the front of joint lines: knee joint and hock joint, and to the centre of the sole. Before the examinations began, each parent had read the examination protocol and consented in writing to the child’s participation. The examination was conducted by a doctor specialising in motor rehabilitation. During each examination, a nursery physical education teacher was present. The criteria according to which children qualified for the examination were: the consent of parents and nursery principals to conducting examinations and the lack of diagnosed developmental anomalies in the assessed children. A specially prepared questionnaire for parents was also used in the study. The questions concerned the age of the child, the Apgar score at birth, medical history, participation in corrective gymnastics, the manner of spending free time at home as well as the lifestyle preferred in the family and the time which parents spent at work. Statistical methods The statistical analysis was conducted using the statistical package StatSoft. Inc. 2011 STATISTIKA version 10.0 and an Excel spreadsheet. Quantitative variables were characterised using the arithmetic mean, standard deviation, the median, the minimum and maximum value as well 95% CI confidence interval. Qualitative variables, in turn, were presented using number and percentage values. To verify whether the quantitative variable came from a normally distributed population, the W Shapiro-Wilk test was used. The significance of differences between the two groups (model of independent variables) was examined with tests of difference significance: Student’s t-test or the Mann-Whitney U test. Chisquare tests for independence were used for qualitative variables. In all calculations, the significance level was adopted as p≤0.05. dency to foot deformity was confirmed, more often this irregularity occurred in children from the state nursery, and the differences were statistically significant (Chi2=5.27, p=0.02). In 14% (7) children no irregularities in body posture were found. In a group of 32% (6), a slight winging of the scapula was found, although the difference was not significant. Children with properly arched feet stayed outside significantly longer (Z=2.39,p=0.02). Table1. Group characteristics State N=24 Private N=26 Together N=50 p value mean±SD 4.0±0.1 4.5±0.9 4.3±0.7 Z=-2.00 range 4.0-4.5 3.0-6.0 3.0-6.0 p=0.04 median 4.0 4.5 4.0 95%CI (4.0 – 4.1) (4.1 - 4.8) (4.1 - 4.4) female 10 (41.7%) 12 (46.2%) 22 (44.0%) Chi2=0.10 male 14 (58.3%) 14 (53.8%) 28 (56.0%) p=0.75 Variables Age Sex Weight mean±SD 17.1±2.4 18.0±3.8 17.6±3.2 Z=-0.63 range 12.0-22.0 12.0-30.0 12.0-30.0 p=0.53 median 16.8 18.0 17.0 95%CI (16.0 – 18.1) (16.5 - 19.6) (16.6 - 18.5) mean±SD 1.1±0.1 1.1±0.1 1.1±0.1 t=-0.77 range 1.0-1.2 0.9-1.3 0.9-1.3 p=0.44 median 1.1 1.1 1.1 95%CI [1.1;1.1] [1.1;1.1] [1.1;1.1] Height BMI mean±SD 14.4±1.7 14.8±2.2 14.6±2.0 Z=-0.79 range 11.8-19.6 10.4-19.8 10.4-19.8 p=0.43 median 14.0 14.3 14.1 95%CI (13.7 - 15.1) (13.9 - 15.7) (14.0;15.2) Standards obesity 1 (4.2%) 1 (3.8%) 2 (4.0%) Z=0.85 overweight 0 (0.0%) 5 (19.2%) 5 (10.0%) p=0.39 normal 11 (45.8%) 8 (30.8%) 19 (38.0%) underweight considerable underweight Apgar score median 7 (29.2%) 8 (30.8%) 15 (30.0%) 5 (20.8%) 4 (15.4%) 9 (18.0%) 10.0 10.0 10.0 Z=0.09 range Stay i n the nursery mean±SD 6.0-10.0 7.0-10.0 6.0-10.0 p=0.93 7.9±0.8 7.1±1.0 7.5±1.0 Z=3.11 range 5.0-9.0 4.0-8.0 4.0-9.0 p=0.002 median 95%CI III. RESULTS In more than one-third of children - 34% (17) a ten- 27 8.0 (7.5 -8.2) 7.0 (6.7- 7.5) 8.0 (7.2 - 7.7) ● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.3/2014 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● IV. DISCUSSION Changes occurring in the physical, psychological and emotional development of children have an influence on the proper body posture [13,14]. It is a time when the child develops its body, motor skills and abilities [15]. Limited movement in favour of entertainment, e.g. television, video games, may lead to irregularities in the shaping of body posture in children in the development period [10,15-17]. The study has shown that children from the state nursery stayed longer outdoors during the day and during the week, while children from the private nursery watched television longer and spent less time on spontaneous play outdoors. The results point to a low awareness of parents of children from the private nursery concerning the fulfilment of the need for outdoor movement, which is natural at that age, and the need to limit passive forms of spending free time. In the study by Rotter et al. [18] conducted among preschool children, it has been found that parents are aware of the necessity to examine and assess body posture and of the importance of prevention, but they do not understand the role of exercise at home. Postural defects in children in development age occur in approximately 50-60% of the population and are mostly caused by a firmly rooted bad habit or a forced load on the body. [18-20]. Such a load may be related to overweight and obesity. In the author’s own research, neither overweight nor obesity was confirmed in the examined group of children. Puzder et al., in turn, have found a positive correlation of the Body Mass Index and knee valgus and valgus flat feet in children aged 9 [20-22]. In the author’s own examinations, only seven children did not have any defect, and these were mostly children attending the private nursery, whereas 43 were found to have various irregularities related to flat and valgus feet and the tendency to a rounded back. The most frequent irregularity among the examined group was the tendency to valgus feet, a slight winging of the scapula and internal rotation in the hip joints. Properly shaped and arched feet were found in children who spent much more time outdoors. Leszczewska and Czaprowski have presented functional correlations in the kinematic chain of the lower limbs, pelvis and spine and they have demonstrated a correlation between flat feet and deformations of lower limb axes [23]. Similarly, in studies by Walczak and Misterska, valgus knee was found in 10% of the examined children, and valgus foot in 36% [24,25]. Moreover, the authors have demonstrated a correlation between flat foot and valgus knee, but they have not established a correlation between excessive body weight and a val- 28 gus flat foot. An analysis conducted by DemczukWłodarczyk demonstrated that transverse flat foot is visible in girls from 3 years of age and in boys from 4 years of age [26]. The improper position of shoulders and scoliosis have been presented by Widłak as postural defects occurring in 84,1% of children from a rural background [26]. The causes of postural defects and their consequences in the motor system cause unfavourable changes and chain reactions [16] and they may also serve to predict potential deviations appearing during further development. In the analysed literature of the subject, postural defects among schoolchildren during the so-called developmental milestones are discussed most frequently; perhaps an earlier observation could effectively prevent the progress of irregularities. When a postural defect is detected in a child, an orthopaedic examination is necessary as well as a relevant correctional treatment. The active participation of parents in exercising at home is crucial, as well as the awareness of the purpose and general rules of conducting such exercises. Undoubtedly, a regular health-oriented instruction contributes to limiting the frequency of postural defects, because acquired habitual defects are related to certain activities can be initially corrected easily. The early detection of changes in body posture enables their early correction. V. CONCLUSIONS 1. In the examined group, most children were found to have irregularities in body posture. Therefore, it is reasonable to conduct a control assessment of body posture in the same group in order to monitor the irregularities. 2. A relatively small group of patients and subjective measurement methods create the risk of error in the assessment of changes, and therefore another assessment should be made by the same examining person. 3. It is useful to assess body posture in preschool children in order to diagnose irregularities early and commence a correctional treatment. VI. REFERENCES [1] GUS Portal Informacyjny.: Liczebność i struktura demograficzna. 25.11.2009. Dostępny w Internecie: www.stat.gov.pl. [dostęp 25.04.2014]. [2] Maciałczyk-Paprocka K. Epidemiologia wad postawy. Rozprawa doktorska. Poznań; Zakład Epidemiologii ● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.3/2014 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● Katedry Medycyny Społecznej UM im. K. Marcinkowskiego w Poznaniu; 2013. [3] Zyznawska J , Kopański Z, Wojciechowska M, Antos E, Uracz W , Brukwicka I . Adaptation of the disabled to work. JPHNMR; 2013, 1:16-19. [4] Stawarz B, Sulima M , Lewicka M, Brukwicka I, Wiktor H. Health and determinants of health - a review of literature, p.I. JPHNMR; 2014, 2:4-10. [5] Stawarz B, Sulima M , Lewicka M, Brukwicka I, Wiktor H. Health and determinants of health - a review of literature, p.II. JPHNMR; 2014,(2:11-16. [6] Sobera M. Charakterystyka procesu utrzymywania równowagi ciała u dzieci w wieku 2-7 lat. Studia i monografie. Wrocław; Wyd. AWF, 2010; 97: 40-83. [7] Nowotny J. Nowotny-Czupryna O. Czupryna K. Rottermund J. O skoliozach inaczej. (cz.I) Podstawy fizjologiczne i fizjopatologiczne terapii skolioz. Prz Med U R i N I L w Warszawie; 2012, 3: 341-350. [8] Puszczałowska-Lizis E. Weryfikacja trafności doboru wskaźników do oceny ukształtowania stopy na podstawie badań stóp kobiet w wieku 20-27 lat. Rehab Med; 2011, T. 15 (2): 9-14 [9] Czaprowski D, Pawłowska P, Gębicka A, Sitarski D, Kotwicki T. Powtarzalność, zgodność i rzetelność pomiaru krzywizn przednio-tylnych kręgosłupa z wykorzystaniem inklinometru cyfrowego Saundersa. Ortop Traumatol Rehab; 2012, 2 (6), Vol 14: 145-153. [10] Kasperczyk T. Wady postawy ciała-diagnostyka i leczenie. Kraków; Wyd. Kasper, 2004. [11] Drzał-Grabiec J, Snela S, Walicka-Cupryś K. Wysklepienie łuku podłużnego stóp a typ postawy ciała. Probl Hig Epidemiol; 2012, 93 (4): 718-721. [12] Latalski M, Bylina J, Fatyga M, Repko M, Filipovic M, Jarosz MJ, Borowicz KB, Matuszewski Ł, Trzpis T. Risk factors of postural defects In children AT school age. Ann Agric Environ Med; 2013, 20 (3): 583-587. [13] de Onis M, Woynarowska B. Standardy WHO rozwoju fizycznego dzieci w wieku 0-5 lat i możliwości ich wykorzystania w Polsce. Med. Wieku Rozwoj; 2010, 14, 2: 87-94. [14] Palczewska I, Woynarowska B. Test przesiewowy do wykrywania zaburzeń w rozwoju fizycznym. W: Testy przesiewowe do wykrywania zaburzeń stanu zdrowia i rozwoju u dzieci w wieku 0-5 lat. Jodkowska M., Mikiel-Kostyra K., Oblacińska A. (red.). Warszawa; Instytut Matki i Dziecka, 2011: 7-21. [15] Frączek B, Gacek M, Klimek AT. Aktywność fizyczna a ruchliwość dzieci przedszkolnych ze środowiska wielkomiejskiego w opinii rodziców. Antropomotoryka; 2013, Vol. 23, 61: 37-44. [16] Kutzner-Kozińska M. Proces korygowania wad postawy. Warszawa; Wyd. AWF, 2004. [17] Dega W. Ortopedia i rehabilitacja. Tom I. Wady postawy. Warszawa; Wyd. PZWL, 1983. 29 [18] Rotter I, Wicher J, Żułtak−Bączkowska K, Mroczek B, Karakiewicz B. Profilaktyka i korekcja wad postawy u dzieci w wieku przedszkolnym w opinii rodziców. Fam Med Primary Care Rev; 2009, Vol. 11, 3: 471-472. [19] Gwizdała W, Grabarek E,., Madej E. Ocena postawy ciała dzieci szkół podstawowych i gimnazjów środowiska miejskiego i wiejskiego w świetle informacji z piśmiennictwa. Kwart Ortop; 2013, 2: 261. [20] Puzder A, Gworys K, Kowalewska E, Durka S, Kulikowska B, Kujawa J. Ocena występowania zaburzeń statyki kończyn dolnych wśród dzieci z regionu miejskiego i wiejskiego- badania pilotażowe. Kwar Ortop; 2011, 4: 377. [21] Wrocławskie Centra Korekcji Wad Postawy. Program profilaktyki wad postawy dla dzieci i młodzieży szkolnej. Okres realizacji programu – styczeń 2011 grudzień 2013. Dostepny w Internecie: iwroclaw.pl/wps/wcm/connect. [dostęp 28.04.2014] .