Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-28T13:06:03.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Motor development in children with congenital cardiac diseases compared to their healthy peers

Published online by Cambridge University Press:  01 October 2007

Birna Bjarnason-Wehrens ,
Sigrid Dordel ,
Sabine Schickendantz ,
Constanze Krumm ,
Daniel Bott ,
Narayanswami Sreeram  and
Konrad Brockmeier
Birna Bjarnason-Wehrens*
Affiliation:
Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
Sigrid Dordel
Affiliation:
Institute for School Sports and School Development, German Sport University Cologne, Germany
Sabine Schickendantz
Affiliation:
Department of Paediatric Cardiology, University of Cologne, Germany
Constanze Krumm
Affiliation:
Institute for School Sports and School Development, German Sport University Cologne, Germany
Daniel Bott
Affiliation:
Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
Narayanswami Sreeram
Affiliation:
Department of Paediatric Cardiology, University of Cologne, Germany
Konrad Brockmeier
Affiliation:
Department of Paediatric Cardiology, University of Cologne, Germany
*
Correspondence to: PD Dr Birna Bjarnason-Wehrens, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Carl-Diem Weg 6, 50933 Cologne, Germany. Tel: 00 49 221 49825020; Fax: 00 49 221 4912906; E-mail: bjarnason@dshs-koeln.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Their perceptual and motor experiences determine the physical and motor development of children, and impact also on their emotional, psychosocial, and cognitive development. Our aim, therefore, was to evaluate motor development in children with congenitally malformed hearts compared to their healthy peers.

We compared 194 children, with a mean age of 10.0 years, and standard deviation of 2.7 years, representing the entire spectrum of congenital cardiac disease, to a control group of 455 healthy children, having a mean age 9.6 years, with standard deviation of 2.17 years. The bodily coordination test for children was used to examine motor development.

Of the children with congenitally malformed hearts, 26.8% showed moderate, and 31.9% had severe disturbances of motor development, compared to 16.5% and 5.5% of the control group, the p-value for these differences being less than 0.001. The mean motor quotient adjusted for age and gender was lower in the children with congenitally malformed hearts than in their healthy peers, at 79.6, with standard deviation of 18.9 as opposed to 96.6, with standard deviation of 15, this difference having a p-value of less than 0.001. Depending on the presence, and/or the degree, of residual sequels, the children with congenitally malformed hearts were divided into two subgroups, with either no or mild residual sequels, or with significant sequels. The mean motor quotient was lower in those with significant residual sequels, at 75, with standard deviation of 19.3, as opposed to 83, with standard deviation of 17.9, the p-value for this difference being less than 0.01. In both subgroups, the mean motor quotient was lower, with a p-value of less than 0.01, than in the control group.

Our findings show that children with congenitally malformed hearts have deficits in their motor development, these being found in the presence of no or mild sequels, as well as with significant residual sequels. Parental overprotection may contribute to these findings.

Keywords

motor abilitiesphysical activityoverprotectionresidual sequelscyanotic heart defectsopen heart surgery
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007 , pp. 487 - 498
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Allen DH, Gutgesell HP, Clark EB (eds). Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. Including the Fetus and Young Adults. 6th edition. Vol. 1&2. Lippincott Williams & Wilkins, Philadelphia, 2001.Google Scholar
2. American Heart Association. Youth and Cardiovascular Diseases – Statistics. Available at http://www.americanheart.org/downloadable/heart/1110821457608FS11YTH5.REVDOC.DOC. (Accessed 30 May 2005).Google Scholar
3. Bruckenberger E. Herzbericht 2004 mit Transplantationschirurgie. Hannover, 2005.Google Scholar
4.Singer, H. Einfluss angeborener Herzfehler auf die Entwicklung von Kindern und Jugendlichen. In: Bjarnason-Wehrens, B, Dordel, S (eds). Motorische Förderung von Kindern mit angeborenen Herzfehlern. Academiaverlag, Sankt Augustin, 2001, pp 9–25.Google Scholar
5.Bar-Or, O. Pediatric sports medicine for the practitioner: from physiologic principles to clinical application. Springer, Berlin-Heidelberg-New-York-Tokyo, 1983.CrossRefGoogle Scholar
6.Brandhagen, DJ, Feldt, RH, Williams, DE. Long-term psychologic implications of congenital heart disease: a 25-year follow-up. Mayo Clin Proc 1991; 66: 474–479.CrossRefGoogle ScholarPubMed
7.Kong, SG, Tay, JS, Yip, WC, Chay, SO. Emotional and social effects of congenital heart disease in Singapore. Aust Paediatr J 1986; 22: 101–106.Google ScholarPubMed
8.Van Dongen-Melman, JE, Sanders-Woudstra, JA. Psychosocial aspects of childhood cancer: a review of the literature. J Child Psychol Psychiatry 1986; 27: 145–180.CrossRefGoogle Scholar
9.Utens, EM, Verhulst, FC, Erdman, RA, et al. . Psychosocial functioning of young adults after surgical correction for congenital heart disease in childhood: a follow-up study. J Psychosom Res 1994; 38: 745–758.CrossRefGoogle ScholarPubMed
10.Uzark, K, Jones, K. Parenting stress and children with heart disease. J Pediatr Health Care 2003; 17: 163–168.CrossRefGoogle ScholarPubMed
11.DeMaso, DR, Campis, LK, Wypij, D, Bertram, S, Lipshitz, M, Freed, M. The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease. J Pediatr Psychol 1991; 16: 137–149.CrossRefGoogle ScholarPubMed
12.Ratzmann, U, Schneider, P, Richter, H. Psychologische untersuchung bei familien, kindern und jugendlichen nach operatio angeborener herzfehler (Fallotsche tetralogie und aortenisthmusstenose). Kinderärztl. Praxis 1991; 59: 107–110.Google Scholar
13.Bellinger, DC, Wypij, D, duDuplessis, AJ, et al. . Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1385–1396.CrossRefGoogle ScholarPubMed
14.Bellinger, DC, Wypij, D, Kuban, KC, et al. . Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526–532.CrossRefGoogle ScholarPubMed
15.Dordel, S, Bjarnason-Wehrens, B, Lawrenz, W, et al. . Efficiency of psychomotor training of children with (partly-) corrected congenital heart disease. Z Sportm 1999; 50: 41–46.Google Scholar
16.Stieh, J, Kramer, HH, Harding, P, Fischer, G. Gross and fine motor development is impaired in children with cyanotic congenital heart disease. Neuropediatrics 1999; 30: 77–82.CrossRefGoogle ScholarPubMed
17.Unverdorben, M, Singer, H, Trägler, M, et al. . Impaired coordination in children with congenital heart disease – only hardly to be explained by medical causes. Herz/Kreisl 1997; 29: 181–184.Google Scholar
18. Schilling F. Körperkoordinationstest für Kinder. KTK Manual. [Body-Coordination-Test for Children, Test Manual] Beltz-Verlag, Weinheim, 1974.Google Scholar
19. Bös K (Ed). Handbuch Motorischer Tests. Hofgräfe, Göttingen, 2001, pp 173-176.Google Scholar
20.Bjarnason-Wehrens, B, Sticker, E, Lawrenz, W, et al. . Die kinderherzgruppe (KHG) – positionspapier der DGPR. Z Kardiol 2005; 94: 860–866.Google Scholar
21.Fredriksen, PM, Ingjer, F, Nystad, W, Thaulow, E. A comparison of VO2(peak) between patients with congenital heart disease and healthy subjects, all aged 8–17 years. Eur J Appl Physiol Occup Physiol 1999; 80: 409–416.CrossRefGoogle ScholarPubMed
22.Fredriksen, PM, Kahrs, N, Blaasvaer, S, et al. . Effect of physical training in children and adolescents with congenital heart disease. Cardiol Young 2000; 10: 107–114.CrossRefGoogle ScholarPubMed
23.Fredriksen, PM, Veldtman, G, Hechter, S, et al. . Aerobic capacity in adults with various congenital heart diseases. Am J Cardiol 2001; 87: 310–314.CrossRefGoogle ScholarPubMed
24.Longmuir, PE, Tremblay, MS, Goode, RC. Postoperative exercise training develops normal levels of physical activity in a group of children following cardiac surgery. Pediatr Cardiol 1990; 11: 126–130.CrossRefGoogle Scholar
25.Longmuir, PE, Turner, JA, Rowe, RD, Olley, PM. Postoperative exercise rehabilitation benefits children with congenital heart disease. Clin Invest Med 1985; 8: 232–238.Google ScholarPubMed
26.Reybrouck, T, Bisschop, A, Dumoulin, M, van der Hauwaert, LG. Cardiorespiratory exercise capacity after surgical closure of atrial septal defect is influenced by the age at surgery. Am Heart J 1991; 122 (4 Pt 1): 1073–1078.CrossRefGoogle ScholarPubMed
27.Rhodes, J, Curran, TJ, Camil, L, et al. . Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 2005; 116: 1339–1345.CrossRefGoogle ScholarPubMed
28.Ruttenberg, HD, Adams, TD, Orsmond, GS, Conlee, RK, Fisher, AG. Effects of exercise training on aerobic fitness in children after open heart surgery. Pediatr Cardiol 1983; 4: 19–24.CrossRefGoogle ScholarPubMed
29.Weipert, J, Koch, W, Haehnel, JC, Meisner, H. Exercise capacity and mid-term survival in patients with tricuspid atresia and complex congenital cardiac malformations after modified Fontan-operation. Eur J Cardiothorac Surg 1997; 12: 574–580.CrossRefGoogle ScholarPubMed
30.Norgaard, MA, Lauridsen, P, Helvind, M, Pettersson, G. Twenty-to-thirty-seven-year follow-up after repair for Tetralogy of Fallot. Eur J Cardiothorac Surg 1999; 16: 125–130.CrossRefGoogle ScholarPubMed
31.Schaffer, R, Berdat, P, Stolle, B, Pfammatter, JP, Stocker, F, Carrel, T. Surgery of the complete atrioventricular canal: relationship between age at operation, mitral regurgitation, size of the ventricular septum defect, additional malformations and early postoperative outcome. Cardiology 1999; 91: 231–235.CrossRefGoogle ScholarPubMed
32.Hutter, PA, Kreb, DL, Mantel, SF, Hitchcock, JF, Meijboom, EJ, Bennink, GB. Twenty-five years’ experience with the arterial switch operation. J Thorac Cardiovasc Surg 2002; 124: 790–797.CrossRefGoogle ScholarPubMed
33.Deanfield, J, Thaulow, E, Warnes, C, et al. . Management of grown up congenital heart disease. Eur Heart J 2003; 24: 1035–1084.CrossRefGoogle ScholarPubMed
34.Wernovsky, G, Newburger, J. Neurologic and developmental morbidity in children with complex congenital heart disease. J Pediatr 2003; 142: 6–8.CrossRefGoogle ScholarPubMed
35.Wypij, D, Newburger, JW, Rappaport, , et al. . The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1397–1403.CrossRefGoogle ScholarPubMed
36.Newburger, JW, Wypij, D, Bellinger, DC, et al. . Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 2003; 143: 67–73.CrossRefGoogle ScholarPubMed
37.Dunbar-Masterson, C, Wypij, D, Bellinger, DC, et al. . General health status of children with D-transposition of the great arteries after the arterial switch operation. Circulation 2001; 104 (12 Suppl 1): I138–142.CrossRefGoogle ScholarPubMed
38.Collins, WA, Maccoby, EE, Steinberg, L, Hetherington, EM, Bornstein, MH. Contemporary research on parenting. The case for nature and nurture. Am Psychol 2000; 55: 218–232.Google ScholarPubMed
39.Dolgin, MJ, Phipps, S, Harow, E, Zeltzer, LK. Parental management of fear in chronically ill and healthy children. J Pediatr Psychol 1990; 15: 733–744.CrossRefGoogle ScholarPubMed
40.Carey, LK, Nicholson, BC, Fox, RA. Maternal factors related to parenting young children with congenital heart disease. J Pediatr Nurs 2002; 17: 174–183.CrossRefGoogle ScholarPubMed
41.Morelius, E, Lundh, U, Nelson, N. Parental stress in relation to the severity of congenital heart disease in the offspring. Pediatr Nurs 2002; 28: 28–32.Google Scholar
42.Van Horn, M, DeMaso, DR, Gonzalez-Heydrich, J, Erickson, JD. Illness-related concerns of mothers of children with congenital heart disease. J Am Acad Child Adolesc Psychiatry 2001; 40: 847–854.CrossRefGoogle ScholarPubMed
43.Swan, L, Hillis, WS. Exercise prescription in adults with congenital heart disease: a long way to go. Heart 2000; 83: 685–687.CrossRefGoogle ScholarPubMed
44.Driscoll, DJ. Exercise rehabilitation programs for children with congenital heart disease: a note of caution. Pedriatric Exercise Science 1990; 2: 191–196.CrossRefGoogle Scholar
45.Fahey, JT. Congenital heart disease – shunt lesions and cyanotic heart disease. In: Goldberg, B (ed). Sports and exercise for children with chronic health conditions. Guidelines for participation from leading pediatric authorities. Human Kinetics, Champaign, 1995, pp 207–224.Google Scholar
46.Goldberg, B. Sports and exercise for children with chronic health conditions. Guidelines for participation from leading pediatric authorities. Human Kinetics, Champaign, 1995.Google Scholar
47.Graham, TP Jr, Driscoll, DJ, Gersony, WM, Newburger, JW, Rocchini, A, Towbin, JA. Task Force 2: congenital heart disease. J Am Coll Cardiol 2005; 45: 1326–1333.CrossRefGoogle ScholarPubMed
48.Hirth, A, Reybrouck, T, Bjarnason-Wehrens, B, Lawrenz, W, Hoffmann, A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease. A consensus document. Eur J Cardiovasc Prev Rehabil 2006; 13: 293–299.Google ScholarPubMed
49.Kaminer, SJ, Hixon, RL, Strong, WB. Evaluation and recommendations for participation in athletics for children with heart disease. Curr Opin Pediatr 1995; 7: 595–600.CrossRefGoogle ScholarPubMed
50.Mitchell, JH, Maron, BJ, Epstein, SE. 16th Bethesda Conference: Cardiovascular abnormalities in the athlete: recommendations regarding eligibility for competition. October 3–5, 1984. J Am Coll Cardiol 1985; 6: 1186–1232.Google ScholarPubMed
51.Picchio, FM, Giardini, A, Bonvicini, M, Gargiulo, G. Can a child who has been operated on for congenital heart disease participate in sport and in which kind of sport? J Cardiovasc Med (Hagerstown) 2006; 7: 234–238.CrossRefGoogle ScholarPubMed
52.Reybrouck, T, Mertens, L. Physical performance and physical activity in grown-up congenital heart disease. Eur J Cardiovasc Prev Rehabil 2005; 12: 498–502.CrossRefGoogle ScholarPubMed
53.Sklansky, MS, Bricker, JT. Guidelines for exercise and sports participation in children and adolescents with congenital heart disease. Prog Pediatr Cardiol 1993; 2: 55–66.CrossRefGoogle Scholar
54.Strauzenberg, SE. Recommendations for physical activity and sports in children with heart disease. A statement by the Scientific Commission of the International Federation of Sports medicine (FIMS) approved by the executive committee of the FIMS. J Sports Med Phys Fitness 1982; 22: 401–406.Google ScholarPubMed
55.Washington, RL. Cardiac rehabilitation programmes in children. Sports Med 1992; 14: 164–170.CrossRefGoogle ScholarPubMed