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Updated: May 25, 2026
Measurements of Motor Function and Other Clinical Outcome Parameters in Ambulant Children with Duchenne Muscular Dystrophy
Published on: January 12, 2019
Cross-sectional study of motor development among children after the Fontan procedure
Patricia E Longmuir1, Laura Banks, Brian W McCrindle
1Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Ontario, Canada. plongmuir@cheo.on.ca
Insights
Children after the Fontan procedure show delayed gross motor skills, particularly in complex abilities as they age. Early intervention and ongoing monitoring are crucial for their physical development and peer participation.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- The Fontan procedure is a palliative surgery for complex single-ventricle congenital heart defects.
- Children undergoing the Fontan procedure may experience developmental challenges, including motor skill deficits.
- Assessing gross motor skills is vital for understanding functional outcomes and quality of life post-Fontan.
Purpose of the Study:
- To evaluate the gross motor skills (locomotor and object control) in school-aged children following the Fontan procedure.
- To compare these skills against normative data for typically developing peers.
- To identify factors associated with motor skill development in this population.
Main Methods:
- A cross-sectional study involving 55 children (6-10 years old) approximately 5.1 years post-Fontan procedure.
- Gross motor skills assessed using the Test of Gross Motor Development - Version 2.
- Daily activity measured via accelerometry; medical history and parent/child perceptions of activity were also collected.
Main Results:
- Active team sports participation correlated with higher locomotor skills.
- Daily moderate-to-vigorous physical activity and positive parental feedback were linked to better locomotor skills.
- Formal instruction and activity restrictions were associated with higher object control skills.
- Older age, complex medical history, and older age at Fontan surgery were linked to greater motor skill delays.
Conclusions:
- Children post-Fontan procedure achieve basic motor skills later than peers, with deficits persisting and worsening for complex skills.
- Longitudinal monitoring of gross motor development is recommended throughout elementary school.
- Further research into motor skill rehabilitation programs is warranted to enhance physical activity participation.
Objectives:
To determine the gross motor skills of school-aged children after the Fontan procedure and compare the locomotor and object control skills with normative data. Study design This study followed a cross-sectional design.
Setting:
This study was based on hospital outpatient visit, with accelerometry conducted at home. Patients This study included 55 patients, including 22 girls in the age group of 6-10 years, 5.1 years after Fontan. Main outcome measures Test of Gross Motor Development - Version 2, daily activity by accelerometer, medical history review, child and parent perceptions of activity.
Results:
Being involved in active team sports increased locomotor percentile score by 10.3 points (CI: 4.4, 16.1). Preference for weekend outdoor activities (6.9, CI: 2.0, 11.8), performing at least 30 minutes of moderate-to-vigorous physical activity daily (24.5, CI: 7.3, 41.8), and reporting that parents seldom criticise the child's physical activity (21.8, CI: 8.9, 34.8) were also associated with higher locomotor percentile scores (p < 0.01). Object control percentile scores were higher (p < 0.03) with involvement in formal instruction (5.9, CI: 1.1, 10.6) and being restricted to "activities within comfortable limits" (27.6, CI: 7.7, 47.5). Older chronological age (r = 0.28), a more complicated medical history (r = 0.36), and older age at Fontan (r = 0.28) were associated with greater skill delay (p < 0.04).
Conclusions:
Children after Fontan attain basic motor skills at a later age than their peers, and deficits continue for more complex skills as age increases, suggesting a need for longitudinal monitoring of gross motor skill development through the elementary school years. Future research might investigate whether a gross motor skill rehabilitation programme can provide these children with the motor skills needed to successfully participate in a physically active lifestyle with peers.
