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Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 10 October 2023
THE INFLUENCE OF VISUAL OCULOMOTOR ABILITIES, BALANCE
AND POSTURAL CONTROL ON THE PRAXIS ABILITIES OF ATYPICAL
CHILDREN AGED 7-12 YEARS
Putri Sukma Rahayu, Indasah, Prima Dewi K, Novi Yulaikah, Siti Hufita
Institut Ilmu Kesehatan Strada Indonesia Kediri, Indonesia
Email: asyahrilah@gmail.com, indasah.strada@gmail.com,
primadewiku17@gmail.com, noviyulaikah160@gmail.com,
sitihufita1999@gmail.com
Abstract
The main problems in dyspraxia are problems in coordination patterns and motor
skills that require skills and rhythmic movements (motor skills). The foundation of
children's motor skills is visual oculomotor abilities as a function of visual perception
which is able to influence the midline position of the body so that children are able
to achieve a position of static balance (balance) and also dynamic balance (postural
control). The aim of this research is to analyze the influence of the three motor skill
foundations on praxis events in atypical school-aged children. The research was
conducted on 102 samples of children aged 7-12 years at the Asya Therapy Center
Mojokerto. Samples were taken at simple random and divided into 2 groups, namely
the case group (n=54) and the control group (n=48). The research design uses a case
control study where researchers analyze the risk of praxis problems in terms of the
influence of visual oculomotor factors, balance and postural control. Data analysis
used logistic regression analysis which showed a significant value of 0.000
(0.000<0.05) so that from these results it can be seen that visual oculomotor factors,
balance and postural control have a significant influence on praxis problems in
atypical children aged 7-12 year. Apart from that, from the results of calculating the
ods ratio, it was found that the highest ods ratio value was owned by the control
ability.
Keywords: dyspraxia; visual oculomotor; balance; postural control; praxis
INTRODUCTION
Praxis problems in children, often called dyspraxia or better known as DCD
(development Co-ordination Disorder), are in the spotlight in several developed and
developing countries. Based on results from WHO (World Health Organization), the
prevalence of dyspraxia problems in children aged 5-11 years reaches 5% - 6% (in
children aged 7 years 1.8% are diagnosed with severe
developmental coordination problems and 3% with possible problems light
developmental coordination). A comparison of the incidence rates in men and
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women shows a ratio of between 2:1 and 7:1 (American Psychiatric Association &
Association, 1994). Meanwhile, based on data from the dyspraxia foundation, it is
stated that around 5% school age children experience praxis problems and 2% of
them are more severely affected (Andersen-Warren, 2023).
The characteristics of children with dyspraxia shown at elementary school age
include children's difficulties in reading and writing activities, children's difficulties
in carrying out gross motor activities that require rhythmic skills (throwing, catching,
kicking the ball, jumping and jumping activities), children's difficulties in carrying
out motor activities. smooth (the writing is not neat or even illegible), children's
difficulties in maintaining focus and concentration when studying, children's
difficulties in understanding simple commands and multilevel commands, children's
difficulties in adapting patterns to their environment and children's difficulties in the
problem solving process (van Jaarsveld et al., 2016).
If we look at praxis problems in the digital 5.0 era, it shows that children's
activities are mostly spent in static positions. Static positioning and a lack of motor
activity in children cause weak motor skills and coordination in children so that it
can indirectly affect children's praxis abilities (Condon, 2000). Static positioning
patterns have a big influence on children's visual conditions, including children's
visual oculomotor abilities. Visual Oculomotor Ability is the ability of visual
perception to control the position and movement of the eyeballs so that they can
focus when observing an object (de Brouwer et al., 2021).
Visual oculomotor ability is an important aspect of body coordination and
movement abilities. Apart from that, this ability also plays an important role in
understanding the body midline and body balance patterns when standing still
(balance) or moving (postural control). Balance is a person's ability to maintain a
postural position in the midline of the body in both stationary and moving conditions
(Osoba et al., 2019).
The balance system is the most important aspect for regulating head
movements, which contributes to maintaining an upright body posture. This balance
system involves a number of reflex pathways that are responsible for carrying out
compensatory movements and adjusting body position (Oster & Zhou, 2022). If a
child experiences incoordination in the coordination of visual oculomotor abilities,
balance and postural control, this will affect his understanding of the midline of the
body so that it will indirectly affect his praxis abilities (Lane et al., 2019). In this
study, researchers reviewed the influence of the foundation of children's motor skills,
namely visual oculomotor abilities as a function of visual perception which is able to
influence the midline position of the body so that children are able to achieve a
position of static balance (balance) and also dynamic balance (postural control).
Analysis of visual oculomotor abilities, balance and postural control in the group of
dyspraxia children and the control group is expected to provide an overview of the
influence of these three abilities on praxis abilities in school-aged children (7-12
years). Elementary school age children (7-12 years) are a transition period for
children from abstract thinking to the concrete operational stage, namely learning
something by understanding objects or direct situations (Istiqomah & Suyadi, 2019).
RESEARCH METHODS
This research is an observational analytical study with a case control study
design by comparing case groups and control groups based on their exposure status.
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This research was conducted on 102 children from 121 populations with an age range
of 7-12 years who were carried out randomly. The research subjects were divided into
two, namely the case group (n=54) and the control group (n=48). The research was
conducted for 5 days with a quota of 20 research subjects per day.
The test materials provided are the test components of the EASI Scorring Test
which consist of the ideational praxis test (EASI 3:Pr.I), visual oculomotor test (EASI
8: OC&Pr.OC), balance test (EASI 6: Balance), and control test postural (EASI 5:
PC). The Praxis Ideation assessment component is seen from several aspects,
including Tally of Ideas (Variation of movements), speed (speed of finding ideas) and
complexity (complexity in carrying out movements). In the EASI 8 examination
there are 24 test items, consisting of 6 items on the ocular pursuit function, 4 items
on the ocular stabilization function, 4 items on the ocular quick localization function,
8 items on the ocular praxis function and 2 alignment items (Lane, Mailloux, Schoen,
Bundy, May-benson, et al., 2019).
The balance examination (EASI 6: Balance) consists of 12 balance test items
and 2 alignment test items. The examination was carried out twice with a gap of
around 10-20 minutes (Lane et al., 2019).The postural control examination consists
of 7 PC Prone Extention Position test items, 7 PC Supine Flexion Position test items,
1 head Lag item, 2 PC on ball items, 1 PC robot arms item, 3 PC reaching items and
2 alignment test items (Schaaf et al., 2012). After the test is carried out, the resulting
data is input into the EASI Scorring Program (ESP), where the data is then processed
and the percentile results are obtained. The resulting scoring is -3 to 3 where the
criteria that are said to be within normal limits is a score between -1 to 1 (no
problems). At a value less than -1, the child is interpreted as being in the atypical
hyporeactive category, while a value greater than 1 is interpreted as the child being
in the atypical hyperreactive category.
RESULTS AND DISCUSSION
This research was attended by 102 children aged 7-12 years with the highest
distribution at the age of 11 years, namely 31 people (30.4%) and the lowest
distribution at the age of 7 years, namely 5 people (4.9%). The research subjects who
were male were 53 people (51.96%) and the research subjects who were female were
49 people (48.04%). The number of subjects based on the presence or absence of
praxis problems as well as grouping them into the case group (atypical children) was
54 people (52.9%) and the control group (typical children) was 48 people (47.1%).
When taking the ideational praxis test (EASI 3: Pr.I), several research subjects
showed difficulty in interpreting the ideas put forward. For example, when you are
ordered to cosplay as an animal. They verbally name the animal they will imitate
but do not execute complex movements that describe the animal in question. From
this test it can be seen that the subject in question experiences dyspraxia.
The number of research subjects who did not have visual oculomotor
problems was 45 people (44.1%) and those who had visual oculomotor problems
were 57 people (52.94%) consisting of 29 people who experienced praxis problems,
28 people did not experience praxis problems. Examination of children's ideational
praxis abilities using the EASI test 3: Ideational praxis (Pr:I) contains a test of
children's ability to develop ideas when they play a role using their hands, body and
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objects around them. Where this test relies on the child's motor skills (kinesthetic
factors). Over the past two decades numerous studies have shown that eye
movements are controlled and regulated to support accurate hand and body
movements. The movement learning process involves the integration of sensory
information about the movement target before, during, and after the movement and
then deciding which movement to perform and when and where to move (de
Brouwer et al., 2021).
When a child is given an object and then the Tester stimulates the child to
initiate the object, the first thing the body does is create an image of what will be
done to the object. Eyeball movements (visual oculomotor skills) focus on objects
by responding to low velocity eyeball movement patterns and slow movements.
Children with visual oculomotor problems (visual pursuit) show eyeball responses
that tend to be hyperreactive or even hyporeactive. With such oculomotor visual
conditions, it will affect the speed of movement initiation and variations in
movement initiation (Collins et al., 2021).
The number of research subjects who had balance problems was 62 people
(60.8%) and research subjects who did not have balance problems were 40 people
(39.2%). From the results of the regression test regarding the influence of balance
on the praxis abilities of atypical children aged 7-12 years, a significant value was
obtained for the balance variable (X2) of 0.003. This value is smaller than the
research alpha value (0.003<0.05) or it can be said that hypothesis is accepted. This
means that balance has a significant effect on praxis problems in atypical children
aged 7-12 years.
Balance is influenced by neuromuscular and proprioceptive processes (Guler
et al., 2021). Postural stability can be interpreted as an adequate response to center
of mass (COM) problems caused by distractions in the body, motor activity or
conscious interaction with the environment (Ludwig et al., 2020).
The balance test component in EASI 6: Balance includes body posture when
standing in various positions and support. Standing posture is controlled by the
integration of sensorimotor processes to maintain the BOS (Base of Support) with
various supports. However, such control depends on the interaction of
biomechanical constraints (e.g. size and strength), dynamics (e.g. direction and
magnitude of movement), movement strategy (e.g. ankle control, hip control, stride,
etc.), and previous experience (Conner et al., 2019).
The number of research subjects who had postural control problems was 34
people (33.3%) and research subjects who did not have postural control problems
was 68 people (66.7%). During the process of somatosensory maturation and
changes in biomechanical parameters related to growth, stability and postural
control undergo a continuous adaptation process. The central nervous system learns
and optimizes both functions during the child's maturation process, with
somatosensory integration playing an important role. Therefore, perception and
control of body position are key factors (Ziegler et al., 2019). The postural control
system is a coordination mechanism of three systems, namely visual, vestibular, and
proprioception. These three functions are integrated with each other in the brain
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stem and cerebellum, and then by the cerebral cortex to correct and maintain the
stability of body posture through movement responses that involve the work of tonic
muscles, so that the coordination and cooperation of this system produces good
posture control (Shams et al., 2020). The literature describes age dependence in
relation to stability control, for example in the Center of Pressure (COP) reduction
process during maturation. Postural control involves stable and active postural
adaptations in which body segments are aligned perpendicular to each other and is
an important basis for the prevention of postural deficiencies. Therefore changes in
postural stability, or more precisely in COP oscillations, become apparent when
adapting active postures or when these postures worsen (Ludwig et al., 2020).
In the postural control test using EASI 5: postural control (PC) includes supine
lying, prone lying, knelling, standing and sitting on the ball. In these five positions,
research subjects were asked to maintain the COP position of the body so that a
balance pattern could be achieved while or while moving. This ability is needed to
provide continuity and endurance for the body during daily activities which are
dominated by praxis abilities. With stable body postural control, integration of the
somantosensory system which is the basis of motor skills can be achieved well. From
the results of the regression test regarding the influence of postural control on the
praxis abilities of atypical children aged 7-12 years, a significant value was obtained
for the postural control variable (X3) of 0.001. This value is smaller than the research
alpha value (0.001<0.05). This means that postural control abilities have a
significant effect on praxis problems in atypical children aged 7-12 years. Apart from
that, the exposure value for postural control has the highest value compared to
balance and visual oculomotor abilities, namely 5.724. This means that children
who have postural control problems have a high risk of experiencing praxis
problems.
Table 1 Table of Influence on Visual Oculomotor, Balance and Postural
Control on Children's praxis Ability
Omnibus tests of model coefficients
Chi-square
Df
Sig
Step 1
Step
24.761
3
.000
Block
24.761
3
.000
Model
24.761
3
.000
This significant value is smaller than the research alpha value (0.000<0.05) or
it can be said that hypothesis is accepted. This means that visual oculomotor
abilities, balance and postural control have a significant influence on the occurrence
of practical problems in atypical children aged 7-12 years.
CONCLUSION
There is a phenomenon that researchers pay attention to when conducting
research and data analysis. In the visual oculomotor function test of children, there
was a phenomenon in some children who had no praxis problems but had low visual
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occulomotor scores. If we review the history, there is a habit of exposure to gadgets
for more than 1 hour per day. Therefore, further research is needed regarding this
phenomenon.
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