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Children with Attention Deficit Hyperactivity Disorder performed rope jumping at different rates. ADHD group showed greater variation in time between foot jumping and rope whirling tasks. Poor timing perception leads to less accurate performance during rope jumping.
Children with Attention Deficit Hyperactivity Disorder performed rope jumping at different rates. ADHD group showed greater variation in time between foot jumping and rope whirling tasks. Poor timing perception leads to less accurate performance during rope jumping.
Children with Attention Deficit Hyperactivity Disorder performed rope jumping at different rates. ADHD group showed greater variation in time between foot jumping and rope whirling tasks. Poor timing perception leads to less accurate performance during rope jumping.
Timing perception and motor coordination on rope jumping in children with
attention decit hyperactivity disorder Ying-Yi Chen a , Lih-Jiun Liaw b , Jing-Min Liang a , Wei-Tso Hung a , Lan-Yuen Guo a , Wen-Lan Wu a, * a Department of Sports Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Rd., Kaohsiung City, 80708, Taiwan b Department of Physical Therapy, Kaohsiung Medical University, Taiwan a r t i c l e i n f o Article history: Received 14 June 2011 Received in revised form 22 February 2012 Accepted 6 March 2012 Keywords: Attention-decit/hyperactivity disorder (ADHD) Timing Rope jumping a b s t r a c t Objectives: To evaluate timing perception ability and motor coordination in children with ADHD (Attention Decit Hyperactivity Disorder) while rope jumping at different rates. Design and setting: Rope jumping at (1) a constant tempo of 100 for 15 s (RJ-C) and (2) two randomly permutated tempos (80, 100, or 120) for 15 s (RJ-V). Main Outcome Measures: The timing variation while jumping, timing variation while whirling, and hand-foot deviation time in each rope jumping cycle were recorded, to assess the time estimation ability. Participants: 10 children with ADHD (9.65 1.27 years) and 10 children without ADHD (9.93 1.54 years) were recruited. Results: The ADHD group showed greater variation in time between the foot jumping and the rope whirling tasks. Also, the median value of hand-foot deviation time was greater in the ADHD group (3.34 ms) than in the control group (1.75 ms). In RJ-V, the control group was able to modify their pace and respond to the target speed in the post-phase, while the ADHD group could not. Conclusion: Impaired timing perception leads to less accurate performance during rope jumping for ADHD children. The ndings also reveal that poor hand-foot coordination results in poor control of simultaneous movements of the upper and lower limbs during rope jumping. 2012 Elsevier Ltd. All rights reserved. 1. Introduction Time perception is the ability to estimate periods of time of coming events. Processing of timing in shorter intervals is based on skilled movements and cerebellar mechanisms without cognitive control, whereas, in longer intervals, it is associated with attention and working memory (Lewis & Miall, 2003a,b; Rammsayer, 1999). Previous studies have indicated that processing of precise timing tasks and longer timing intervals are associated with the cere- bellum and basal ganglia (Ivry & Keele, 1989; Ivry & Spencer, 2004; Mangels, Ivry, & Shimizu, 1998). The network of right hemispheric frontocerebellar time discrimination has also been shown to be involved in timing tasks (Harrington, Haaland, & Knight, 1998; Smith, Taylor, Lidzba, & Rubia, 2003). The output of motor timing consists of two components: a clock component, which reects time keeper intervals, and a motor delay component, which reects motor implementation delay (Harrington, Haaland, &Hermanowicz, 1998). Previous studies have indicated that children with ADHD have perceptual decits in the clock component, such as in time production and reproduction, which further inuences their performance on motor timing tasks (Barkley, Murphy, & Bush, 2001; Van Meel, Oosterlaan, Heslenfeld, & Sergeant, 2005; Yang et al., 2007). When rope jumping, it is necessary to coordinate the upper and lower body to maintain balance and rhythm. Rope jumping can enhance the precise coordination of multiple muscle groups, which is why it is used widely in athletic training programs (Lee, 2010). Rope jumping combines the angular momentum of the rope and vertical displacement of the body (Pitreli & OShea, 1986). Also, rope jumping involves upper and lower synchrony (hand-foot coordi- nation) where positioning and timing is critical (Pitreli & OShea, 1986). The ability of time reproduction makes it possible to reproduce specied time periods with great precision (Toplak, Dockstader, & Tannock, 2006). Rope jumping skill involves good perception of time reproduction. However, poor motor timing performance has been found in children with ADHD. It seems that timing abnormalities have been related to impulsiveness, a core * Corresponding author. Tel.: 886 7 3121101x2646; fax: 886 7 3138359. E-mail address: wenlanwu@kmu.edu.tw (W.-L. Wu). Contents lists available at SciVerse ScienceDirect Physical Therapy in Sport j ournal homepage: www. el sevi er. com/ pt sp 1466-853X/$ e see front matter 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.ptsp.2012.03.012 Physical Therapy in Sport 14 (2013) 105e109 clinical symptom of ADHD (Rubia, 2002; Rubia, Halari, Christakou, & Taylor, 2009). It has been found that children with ADHD showless activity in regions including the prefrontal and precentral gyri, basal ganglia, cerebellum, inferior parietal lobule, superior temporal gyri, and insula, which are associated with sensorimotor timing (Valera et al., 2010). Thus, they have demonstrated decits in time perception including shorter reproductions and greater reproduction errors than healthy children (Barkley et al., 2001). ADHD children have been shown to be impaired at maintaining a chosen tapping rhythm synchronously and in responding to organize their motor output (Rubia, Taylor, Taylor, & Sergeant, 1999). Children with ADHD showed poor ability to plan events which are separated by time (Barkley, 1997). Also, children with ADHD have problems executing motor output (Pennington & Ozonoff, 1996) and they exhibit slow output on automatic pro- cessing tasks (Carte, Nigg, & Hinshaw, 1996). It has been suggested that children with ADHD have difculty adjusting their speed to motor tasks with external cues (Carte et al., 1996). Much evidence exists to suggest that children with ADHD have impairments in ne motor timing when executing nger tapping tasks. However, few studies have focussed on gross motor timing. Through clinical observation, it was found that children with ADHD showed poor performance when rope jumping. It has been sug- gested that problems with timing perception and motor coordi- nation might be the reason. Thus, in this study, a series of rope jumping tasks involving different rope jumping rates was designed to evaluate the timing perception ability and motor coordination of ADHD children. 2. Methods 2.1. Subjects Five boys and ve girls, with a mean age of 9.65 1.27 years, diagnosed as ADHD by a local hospital and without other combined syndromes, were recruited in this study. Ten age-matched non- ADHDchildren (4 boys, mean age 9.93 1.54 years), without ADHD symptoms or other neuromuscular symptoms, were recruited from local schools as the control group. Rope jumping was already a part of the physical education curriculum at the time of data collection. Informed consent, approved by the university ethical review committee, was obtained from parents prior to involvement in the study. 2.2. Material A force plate (Kistler Instrument Corp, Winterhur, Switzerland) with the sample rate of 1000 Hz was used to record the ight timing of rope jumping. A six-camera motion capture system (Qualisys Motion capture Systems, Qualisys AB, Sweden), with a sample rate of 100 Hz, was used to capture rope movement using a reective label attached to the distal end of the rope. Further- more, the rhythm, as controlled by a metronome, was recorded by a CD player for use as our target signal before the test. 2.3. Procedure A reective label was stuck to the distal end and on the middle of the rope in order to record the trajectory of the rope. Two reective markers were stuck on each side of the third metatarsal head to help judge the ight phase and landing phase during rope jumping. Subsequently, participants were asked to warm up by doing rope jumping for at least 15 s before the formal rope jumping test; they then practiced three cycles at each tempo; 80, 100 and 120. The sounds at the various tempi were played during the task by CDplayer. Each participant was allowed to take a rest during this study. Muscle fatigue was not an issue. Firstly, subjects were required to jump the rope at a constant tempo of 100 for 15 s (RJ-C). After 10 min rest, they were asked to jump at variable speeds, consisting of the tempos of 80e100, 80e120, 100e80, 100e120, 120e80, and 120e100, for 15 s (RJ-V), respectively, in a random order. Each participant was allowed to take a 3 min rest between these 6 trials. Under RJ-V, the tempo was changed at around the 6the7th second during each trial. The tempo of sound for each trial had been recorded before the experiment and was played continuously by CD player. Participants were instructed to do their best to followthe tempo and were required to jump inside the edges of the force platform. Each subject was instructed to nish 2 trials on RJ-C and only 1 trial on each RJ-V task to achieve a total of three acceleration trials and three deceleration trials. If a subject tripped on the rope and failed on the task, then they were asked to do more trials. The number of failures was recorded. 2.4. Data analysis The recurrent period of jumping (foot jumping cycle) was dened as the time span from when the ground reaction force rst excee- ded 10 N until the next time the ground reaction force exceeded 10 N, and so on. Similarly, the period of the rope cycle (rope whirling cycle) was dened by the rope marker reaching the lowest point and contacting ground. The timing variation in jumping and timing variation in whirling were calculated as the absolute value of the difference between 60 and the foot jumping cycle or rope whirling cycle, respectively; multiplied by the reciprocal of the tempo. The timing variation is the inconsistency between the manipulation of time by the performer and the expected manipu- lation of time for the task, the symptom of which is either an extended performance time or a shortened one compared with the expected time. Moreover, we subtracted the timing variation in whirling from the timing variation in jumping and found the absolute value to dene the hand-foot deviation time. In the RJ-C task, two trials were analyzed. Each trial of the RJ-C task was analyzed from 4 to 9 s. In the RJ-V task, 6 different tasks were analyzed. Moreover, each trial of the RJ-V tasks was separated into three phases, which were selected as pre-phase (4e5 s), mid- phase (6e7 s), and post-phase (8e9 s). Finally, the mean values for hand-foot deviation time, timing variation in foot jumping, and timing variation in rope whirling from all the available rope jumping cycles of the RJ-C and RJ-V tasks were recorded. 2.5. Statistical analysis A non-parametric test (Mann Whitney Utest) was used to assess the time difference between the ADHDgroup and the control group for RJ-C and RJ-V from 4 to 9 s. Also, a Mann Whitney U test was used to assess the difference between successful trials and failed trials for RJ-C. The statistical signicance for paired comparisons between each phase was calculated using Wilcoxon Signed-Rank test method. All analyses were performed using SPSS 17.0 soft- ware (SPSS Inc., USA). Results were considered statistically signi- cant when the p-value was less than 0.05. 3. Results Fig. 1(a) displays the median value of hand-foot deviation time from 4 to 9 s across the groups for the RJ-C task. The median value of hand-foot deviation time was greater in the ADHD group (3.34 ms), compared to the control group (1.75 ms) (p<.01, Table 1). Moreover, no falls were found in the control group, but some Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109 106 ADHD-participants fell during the RJ-C task. The median value of hand-foot deviation time was greater in falling trials (7.77 ms) than successful trials (3.34 ms) in the ADHD group (p<.05, Table 1). Fig. 1(b) displays the median of hand-foot deviation time from 4 to 9 s across the groups in the RJ-V task. Also, we found a signicant difference in hand-foot deviation time between groups on the RJ-V task (p<.01, Table 1). The median value of hand-foot deviation time was greater in the ADHD group (4.89 ms) than in the control group (2.93 ms, p<.01, Table 1). Furthermore, each trial of RJ-V tasks was separated into three phases, including pre-phase (4e5 s), mid- phase (6e7 s), and post-phase (8e9 s), to examine their timing variation in foot jumping and timing variation in rope whirling in different phases. Fig. 2 shows performance in foot jumping and rope whirling across the groups in the three phases. It was found that the ADHD group presented greater variation time in both the foot jumping and rope whirling cycle than did the control group. Further, Wilcoxon Signed-Rank test for paired comparisons between the timing variations in each phase were performed (Table 2). Inthe control group, the timing variation infoot jumping in the mid-phase was 12.99 ms (Table 1) greater than it was in the pre- phase (4.39 ms, Table 1) (p<.05, Table 2). Also, in the ADHD group, signicantly greater timing variations in foot jumping were found in the mid-phase (15.13 ms) and post-phase (15.35 ms) than in the pre- phase (4.15 ms) (p<.05 in mid-phase; p<.05 in post-phase, respec- tively, Table 2). In the control group, the timing variation in rope whirling in the mid-phase was higher than in the pre-phase (p<.05, Table 2). Inthe ADHDgroup, the timing variations inrope whirling in the mid-phase (18.21 ms) and post-phase (12.78 ms) were signi- cantly greater than in the pre-phase (6.00 ms) (p<.05 in mid-phase; p<.01 in post-phase, respectively, Table 2). 4. Discussion In this study, the ADHD group demonstrated greater timing variation in both RJ-C and RJ-V tasks (Table 1). Moreover, it is interesting to note that the ADHD group showed greater variation time in the RJ-V task than in the RJ-C task. This suggests that control group subjects could follow the given rate with less timing vari- ability when processing rope jumping; while the ADHD group could not. It also suggests that when conditions changed, the symptoms of ADHD interfered with motor timing performance. Previous studies have shown that greater variability in motor timing is obvious in children with ADHD (Pitcher, Piek, & Barrett, 2002; Rommelse et al., 2008; Rubia et al., 1999). Through func- tional magnetic resonance imaging, individuals with ADHD have Table 1 Descriptive statistics for hand-foot deviation time (ms), timing variation in foot jumping (ms), and timing variation in rope whirling (ms) across group, and the statistical signicance of the hand-foot deviation time (ms) between groups and between success trials and falling trials (median with interquartile range in parentheses). ADHD Control p-value Hand-foot coordination Hand-foot deviation time (ms) RJ-C (4 0 e9 0 ) Success trails 3.34 (4.33/1.33) 1.75 (2.78/1.13) .005** Failing trails 7.77 (12.13/5.86) N/A p-value .028* e RJ-V (4 0 e9 0 ) 4.89 (8.63/3.73) 2.93 (3.33/2.51) .003** Foot jumping cycle Timing variation in foot jumping (ms) Pre-phase (4 0 e5 0 ) 4.15 (21.33/2.75) 4.39 (17.00/2.33) Mid-phase (6 0 e7 0 ) 15.13 (32.75/11.11) 12.99 (17.64/7.00) Post-phase (8 0 e9 0 ) 15.35 (25.43/6.11) 9.22 (11.56/4.38) Rope whirling cycle Timing variation in rope whirling (ms) Pre-phase (4 0 e5 0 ) 6.00 (22.17/4.47) 6.30 (15.78/4.04) Mid-phase (6 0 e7 0 ) 18.21 (27.58/12.11) 13.77 (17.89/6.75) Post-phase (8 0 e9 0 ) 12.78 (24.71/8.11) 9.74 (11.17/3.94) N/A denotes no falling trial; e denotes no p-value. *Denotes p-value < 0.05; **denotes p-value < 0.01. Fig. 2. The median value of timing variation in foot jumping and rope whirling across groups in the pre, mid and post-phase in the task of RJ-V. a b Fig. 1. (a) The interquartile range and median of hand-foot deviation time measured for each group in the task of RJ-C. (b) The interquartile range and median of hand-foot deviation time measured for each group in the task of RJ-V. Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109 107 been shown to have less activity in the prefrontal region, basal ganglia, and cerebellum, which are associated with sensorimotor timing, resulting in wild variability in timing mechanisms (Valera et al., 2010). Previous studies have used tapping tasks to measure the variability of motor output in response to an external cue (Kalff et al., 2005; Rommelse et al., 2008). Children with ADHD displayed impairments in duration discrimination on timing tasks (Toplak, Rucklidge, Hetherington, John, & Tannock, 2003; Yang et al., 2007); therefore, poor timing performance causes them to show slower responses and more variability in processing sequential tapping tasks (Kalff et al., 2005; Pitcher et al., 2002; Rommelse et al., 2008). The ndings of this study reveal that the ADHD group showed greater timing variation on the RJ-C and RJ-V than did the control group, which means less accurate performance when emulating the target signal. The impaired timing perception in ADHD children indeed causes less accurate performance during rope jumping. The RJ-V task was separated into three phases: pre- (4e5 s), mid (6e7 s), and post- (8e9 s), to observe subjects adaptations in each phase. After the rate changed, timing variation in foot jumping and timing variation in rope whirling in the post-phase did not differ from those in the pre-phase in the control group (p .07 in foot jumping; p .20 in rope whirling, Table 2). This indicates that the foot jumping and rope whirling performances were the same in pre-phase and post-phase. This suggests that control group subjects had the ability to adapt quickly to a given rate and dis- played decreased timing variability in the post-phase. However, in the ADHD group, the performance in foot jumping and rope whirling in the post-phase still showed signicant difference compared to the pre-phase (p .02 in foot jumping; p .01 in rope whirling, respectively, Table 2). This indicates that performance in the pre-phase differs from that in the post-phase, without showing signicant decline in timing variation in the post-phase, either in foot jumping or in rope whirling. This nding indicates that chil- dren with ADHD were impaired in time perception and reproduc- tion, compared to children without ADHD. In the task with longer time intervals (over 1 s); subjects relied on attention and cognitive process (Nenadic et al., 2003). However, handling of short intervals (milliseconds) may be more related to an internal timing mechanism (Ivry, 1996). A previous study has demonstrated that participants anticipated the following tone when the interval was less than 3-sec, and then tapped synchro- nously with or before the tone, rather than hearing it (Mates, Mller, Radil, & Pppel, 1994). In this study, jumping intervals of less than 1 s decreased the confounding inuence from cognitive process. Excluding inferences from cognitive process, external cues likes rope swing in a school yard jump rope, were not considered relevant in this study. Thus, the poor performance on rope jumping in this study was more related to ADHD childrens abilities with regard to time perception. Previous research has also suggested that children with ADHD have motor coordination deciency in postural adjustment (Jucaite, Fernell, Forssberg, & Hadders-Algra, 2003), which also has a nega- tive impact ondailylife(Fliers et al., 2008). Inthis study, ropejumpers needed more skill for coordination of upper and lower limb movements. ADHD-participants showed a big drop in overall performanceontheRJ-CtaskandontheRJ-Vtaskwithahigher hand- foot deviationtime. Simultaneously, the ADHDindividuals trippedup more than the others. No control group subject failed on any of the tasks. The experimental results showed that there was greater hand- foot deviationtime (7.77ms, Table1) infallingtrials. This maysuggest that values of hand-foot deviation time closer to zero represent jumpers who manifest synchronous activation of upper and lower extremities during rope jumping. Better performance in rope jump- ing leads to good ability in motor coordination. Therefore, this suggests that ADHD individuals were poor in controlling simulta- neous movements of the upper and lower limbs when facing high quality motor coordination tasks. Further study, testing other coor- dinationtasks is suggestedtounderstandwithgreater condence the overall breakdown in hand-foot coordination in ADHD. There were some limitations to this study. Rope jumping is a gross motor performance task, combining upper and lower limbs. A childs ability to perform this motor skill depends on a number of factors, including muscle strength, coordination, exibility, range of motion, cardiopulmonary endurance, and so on. Muscle strength variations in different school-age children may be an issue that inuences their performance. Therefore, further studies are sug- gested to investigate each participants muscle strength and then observe their performance in coordination tests. In this study, this factor was excluded by asking each participant to do rope jumping 15 s before this study in order to observe their ability on rope jumping. If they could not complete it, they were considered to have weak muscle strength and endurance and were excluded from this study. Leaving aside the muscle strength problem, and taking all other experiential elements to be the same, the performance criterion set up in this study may serve as a reliable diagnostic marker for this complex challenge of observing the precision of internal timing perception in conjunction with motor coordination ability. Moreover, cordless jump rope may be useful to construct a simple task to compare rope jumping with and without rope to observe gross motor coordination skill. 5. Conclusion The ndings suggest that abnormalities in motor coordination and motor timing perception are present in ADHD children during rope jumping. Longer hand-foot deviation time indicated poor rope jumping performance. The ndings reveal that the ADHD group had greater hand-foot deviation time in both RJ-C and RJ-V tasks. Due to the poor timing perception and motor coordination, most children with ADHD could not carry out tasks as well as children without ADHD. Further studies could focus on specic training of time perception skill as well as motor coordination for children with ADHD to improve their rope jumping skill. Conict of interest None declared. Ethical approval Informed consent, approved by the university ethical review committee, was obtained from parents prior to involvement in the study. Funding None declared. 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