|Year : 2020 | Volume
| Issue : 2 | Page : 37-42
The effect of balance and coordination rehabilitation exercises, on serving skills of students with special needs, undergoing vocational training in hospitality and catering department: A prospective one-arm interventional study
Deepa Vasant Udiaver
Department of Occupational Therapy, SPJ Sadhana School, Sophia College Campus, Mumbai, Maharashtra, India
|Date of Submission||24-Mar-2020|
|Date of Decision||01-Apr-2020|
|Date of Acceptance||27-Apr-2020|
|Date of Web Publication||6-Jun-2020|
Dr. Deepa Vasant Udiaver
A-4, Parag, Bank of Baroda CHS, Bamanwad, Sahar Road, Mumbai - 400 099, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Acquiring good serving skills is prerequisite for placement of special need students undergoing vocational training in hospitality and catering department in vocational school. Many studies have been done on balance and coordination on Down's syndrome and Autistic children, but there are no studies done so far on serving skills in these special need students. Objective: The purpose of this study was to determine the effect of occupational therapy (OT) program incorporating rehabilitation balance and coordination training exercises in improving serving skills of special need children in catering and hospitality department, as effective serving skills was the prerequisites for securing a placement for internship in the hospitality industry. Study Design: A prospective one-arm interventional study was chosen for the research. Methods: A total of 15 students with special needs in the age group of 17–23 years who were to be graduated and had to secure internships were assessed. The study was conducted from June 2018 to March 2019. All students were assessed on Static Balance Test, Standing on Right Leg Scale (SORL) and Standing on Left Leg Scale (SOLL), and Hand to Wall Toss Test (HTWTT) for coordination. They were also assessed by the teachers' feedback form of serving skills which were recorded pre and post rehabilitation training. After the baseline scores were recorded, Phase 1 exercises of balance and coordination were given separately on stable surface for 12 weeks; first follow-up scores were recorded. Then, Phase 2 exercises started after 12 weeks which included combination of balance and coordination given on unstable surface and after 24 weeks the second follow readings were recorded. Results: An OT intervention exercises in the combination of balance and coordination was given to students on unstable surface to improve the serving skills of the students. At the end of 12 weeks post-exercises training it showed that SORL improved significantly (P < 0.001), 95% confidence interval (8.79–24.70). The SOLL also improved significantly (P < 0.009), 95% CI (7.59–24.14). Even the HTWTT improved significantly (P < 0.001), 95% CI (12.63–18.83); therefore, the training was significantly helpful in improving balance/coordination at the end of 12 weeks. At 24 weeks also post exercises training the SORL improved significantly (P < 0.009), 95% CI (13.34–33.06). The SOLL also improved significantly (P < 0.001), 95% CI (11.10–30.90). Similarly, HTWTT also improved significantly (P < 0.001), 95% CI (15.96–22.44). Therefore, the training was significantly helpful in improving balance/coordination at the end of 24 weeks. Teachers' feedback questionnaire showed significant improvement (P < 0.000), 95% CI (18.81–22.93). Conclusion: This study shows that OT intervention exercises in the combination of balance and coordination exercise given on unstable surface improve the serving skills of students.
Keywords: Balance, Co-ordination, Serving Skills
|How to cite this article:|
Udiaver DV. The effect of balance and coordination rehabilitation exercises, on serving skills of students with special needs, undergoing vocational training in hospitality and catering department: A prospective one-arm interventional study. Indian J Occup Ther 2020;52:37-42
|How to cite this URL:|
Udiaver DV. The effect of balance and coordination rehabilitation exercises, on serving skills of students with special needs, undergoing vocational training in hospitality and catering department: A prospective one-arm interventional study. Indian J Occup Ther [serial online] 2020 [cited 2021 Jul 28];52:37-42. Available from: http://www.ijotonweb.org/text.asp?2020/52/2/37/286121
| Introduction|| |
In hospitality industry, serving skills play the major role in building good relations with guests. The ability to move at a steady pace, with grace and agility, is important to perform service and requires good balance and coordination skills.
Most of the special need students have impaired balance and muscle strength, incoordination, and slow reaction time, reduced visual-motor control, and gross and fine motor skill dysfunction. Students with Down's syndrome have sensory integration dysfunction as a result of limited sensory experience.
At Sadhana School, special need students are taught serving skills which require good postural stability to hold and balance the tray comprising the bowl filled with food and the jug filled with water which requires good grip and muscular strength of the forearm muscles and good balance.
These kids required good balance training., Furthermore filling the glass with water from the jug without spillage requires good eye-hand coordination. Thus, this long-term neurodevelopmental task training improved their motor control skills required for improving their serving skills in special need kids. Thus, acquiring combination of good balance, bilateral coordination, upper limb strength, speed, and agility of these special need students and its impact on individual ability to serve the guests independently with grace was the prerequisite for placement for internship in corporate hotel industry. Studies have been made on balance and coordination,, in special need students, but no studies have been made on serving skills so far.
Balance is the key to all activities of human performance and co-ordination in its smooth execution of the same and both are required in serving skill in the catering department.
The purpose of this study was to determine the effect of occupational therapy (OT) program incorporating rehabilitation balance and coordination training exercises in improving serving skills of special need children in catering and hospitality.
| Methods|| |
The prospective one-arm interventional study was conducted from June 2018 to March 2019 at S. P. J. Sadhana School. This study was conducted adhering to the principles of “Declaration of Helsinki” and informed consent was obtained from the parents.
The eligibility criteria were as follows: inclusion criteria were both female and male genders, between the age of 15–25 years, who were in the 4th year of the 5-year long hospitality and catering vocational training course and who were to be placed for an internship and difficulty in serving skills. These students were diagnosed as special need students with different diagnoses, with different needs. All these students were intellectually disabled and the group consisted of special need students with the following diagnosis: Down's syndrome (N = 5), autistic spectrum disorder (N = 2), slow learners (N = 4), ADHD (N = 1), delayed milestones (N = 1), fragile X syndrome (N = 1), and mentally retarded (N = 1). The exclusion criteria were as follows: average or above average IQ and students who were not enrolled for training in hospitality industry.
These students faced difficulty in serving skills such as: difficulty during water service, i.e., there was spillage of water while pouring from jug to glass due to impaired coordination and motor planning skills. While serving pastry with pair of tongs, they would crush the pastry, due to inappropriate pressure while picking pastry with pair of tongs due to lack of motor planning. While serving noodles, they had difficulty to manage fork and spoon due to decreased muscle strength of wrist and fingers. During buffet service, they had difficulty in holding large vessel filled with food while transferring food from cooking utensil to chaffing vessels due to low endurance and decreased standing balance. Laying the table, they had difficulty in the placement of plates and cutlery at an appropriate position due to the lack of spatial orientation and motor planning. Effective serving skills were the prerequisite for their internship placement, and hence, they were assessed for these skills and intervention was planned. The study was conducted on 15 students according to the eligibility criteria. Outcome measures were Standing on Right Leg Scale (SORL), Standing on Left Leg Scale (SOLL), Hand to Wall Toss Test (HTWTT), and Teachers Feedback Questionnaire on Serving Skills.
Static Balance Test
SORL and SOLL were used to assess the ability to balance the tray required for serving skills, the students were instructed to carry a medium-sized tray with a medium-sized bowl filled with up to ½ l of water and stand on one leg while the time was being measured in seconds. The student had to hold the tray without their leg touching the ground nor leaning against any surface. The same was done for alternative leg, and a mean of three readings was taken.
The scoring was categorized as excellent: 40, good: 30–39, average: 20–29, fair: 11–19, and poor: <10.
Hand to Wall Toss Test
In HTWTT, the student was required to stand three feet away from the wall, holding a medium-sized ball and was asked to toss the ball against the wall and catch the ball and continue for 30 s timed by countdown timer buzzer of stopwatch. The number of times student could catch the ball in 30 s was counted. The mean of three readings was taken for each student. The scoring was categorized as excellent: >35, good: 30–35, average: 20–29, fair: 15–19, and poor: <15.
Teacher's Feedback Questionnaire of Serving Skills
The test was taken on the task analysis of the serving skills. A questionnaire of 5 items pertaining to balance and coordination was prepared and handed out to teachers to select from a choice of poor, fair, good, and very good, and excellent and points were given ranging from 1 to 5 and the score was obtained for pre and post training sessions.
Occupational Therapy Intervention
After doing the initial baseline scores of the students in June 2018, students were given therapeutic exercises, which lasted for 45 min twice a week which were demonstrated and instructions were given to the students. Exercise regime would start with deep breathing exercises and pranayama exercise with 5 counts hold in a set of 10 followed by warm-up exercises with stretching exercises of the upper limbs, lower limbs, and trunk which were given for 5–10 min followed by the below exercise.
After the initial screening of the special needs students, Occupational Therapy intervention was started which was divided into two phases. [Table 1] shows the exercises regime of two phases.
|Table 1: Balance and Co-ordination Rehabilitation Exercises in Phase 1 and Phase 2 to Improve Serving Skills|
Click here to view
Phase 1: The exercises were given on a stable surface on the mat and floor, for 12 weeks, and then, measurements for the SORL and SOLL alternately, HTWTT, were taken, at the end of Phase 1 of exercise training.
Phase 2: These was started after the first follow-up measurements taken at the end of 12 weeks, and then, the regime of exercises changed to increased graduation when the combination of balance and coordination exercises was given on unstable surfaces such as balance beam, wobble board, and Bosu ball. This exercise program lasted for another 12 weeks and post measurements of SORL, SOLL, HTWTT, and eachers feedback on serving skills were taken at the end of Phase 2 that is at 24 weeks.
Statistical calculations were performed using Statistical Package of the SPSS 20 version of IBM Armonk, New York USA was used for statistical analysis. ANOVA-repeated measure test and paired t-test were used for the statistical analysis. The test parameters' were compared before and after therapy. Repeated ANOVA test was used for standing balance test: SORL and SOLL and HTWT and paired t-test was used for teachers' feedback questionnaire.
| Results|| |
The number of students was 15, of which 8 were female and 7 were male ranging from the age group of 17–23 years who were in the 4th year of the 5-year long hospitality and catering vocational training course and were to be placed for an internship in corporate hotel industry.
[Table 2] represents Annova Repeated Measure Test of SORL showing the correlation between the mean and SD at baseline, post exercise 12 weeks and post exercise 24 weeks. The improvement from 0 to 12 weeks was P ≤ 0.001; therefore, the test was highly significant. 95% confidence interval (CI) value was 8.79–24.70.
|Table 2: Standing on Right Leg ANOVA-Repeated Measures Between Variables|
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At 24 weeks, the improvement was P ≤ 0.001 which is less than 0.05, so the test was highly significant. 95% CI value was 13.34–33.06. [Table 3] represents Annova Repeated measure Test of SOLL showing the co- relation of the mean and SD at baseline, post exercise 12 weeks and post exercise at 24 weeks. The improvement from 0 to 12 weeks was P ≤ 0.009 that is less than 0.05; therefore, the test was highly significant. 95% CI value was 7.59–24.14.
|Table 3: Standing on Left Leg: ANOVA-Repeated Measures Between Variables|
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At 24 weeks, the improvement was P ≤ 0.001 which is less than 0.05, so the test was highly significant.
95% CI value was 11.10–30.90 [Table 4] shows ANOVA-repeated measure test for HTWTT after Phase 1, P ≤ 0.001, and the test was significant.
|Table 4: Hand to Wall Toss Test: ANOVA-Repeated Measures Between Variables|
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At 12 weeks, P ≤ 0.001, the test was highly significant. 95% CI value was 12.63–18.83.
At 24 weeks, P ≤ 0.001, it was highly significant. 95% CI value was 15.96–22.44. [Table 5] shows that this study has helped to improve the serving skills, based on the analysis of qualitative data from the teachers' feedback questionnaire, which is statistically confirmed on Paired t-test where P ≤ 0.000, which is less than 0.05; hence, the test was highly significant.
At 12 weeks, 95% CI value at the baseline was 11.33–17.31 and at 24 weeks, 95% CI value was 18.81–22.93.
| Discussion|| |
In the initial Phase 1 of the study, OT assessment of these special need students revealed weak abdominal muscles, weak trunk musculature, and low endurance and instant occurrence of fatigued due to weak cardiovascular systems. Muscular imbalance occurs when opposing muscle groups lack normal range and strength of the trunk and commonly exhibits strength imbalance in such special need kids.
In this study, the rehabilitation exercises of core abdominal and trunk strengthening exercises given on mat in Phase 1 and on swiss ball in Phase 2 helped the strengthening and stabilization of the deep muscles of the trunk which controlled the dynamic orientation of the lower extremity, improving their postural stability, static balance strength, and endurance., Core stability strengthening improved the static balance, by developing their strength and endurance in Down's syndrome. Hence, there was an improvement in balancing the tray with a bowl of curry and jug with water while walking to the table during serving skills, as shown in the teachers' feedback test.
Balance involves the interaction of anatomic postural and voluntary motor commands of both the trunk and limb musculature of these students.
Balance is the process of integrating sensory input from multiple sources (vestibular, kinesthetic, tactile, and visual) to plan and execute static and dynamic postures is an integral part of almost every movement task a person might perform. Maintenance of postural balance requires an active sensory control, influenced by proprioceptive and visual vestibular afferent on postural control in these special need students. The vestibular system is important for the development of antigravity postures and balance. It is also one's ability to maintain equilibrium in the gravitational field by keeping the center of body mass over a base of support. In this study, it was found that the ability to maintain balance while standing, walking was necessary for all catering students.
The difficulty which these special needs students seem to suffer was from increased postural sway. During training, the biomechanical, kinesthetic, and proprioceptive cues helped to bring about the change in their neuromuscular coordination, and so the students had to adapt to challenging changes of dynamic patterns of neural activity, which improved the strength of the triceps surae muscle, in turn, reduced their postural sway. In this study, a significant improvement in static balance found in these special need students attributed to activation of the mechanoreceptors, the neural activity, and proprioceptive and vestibular systems, thus improving their joint and kinesthetic sensation during training in balance exercises. Balancing on Wobble board can involve unanticipated perturbations of both trunk and limb muscles. Wobble board training, balance training on unstable surface, improved the strength of lower extremities and proprioception. The improvement in serving skill of balancing the tray in one hand and maneuvering laying the table or clean the table with other hand is possible which corresponds to Teachers observation feedback form.
After the rehabilitation Intervention of phase 2, the following findings were seen.
Students while serving pastry could gauge and apply appropriate pressure to pair of tongs and serve the pastry with grace without crushing it. Also while serving pasta/noodles with a pair of tongs; they could do it skillfully without spilling it over.
During Water service, while filling water from jug to glass, could be possible up to appropriate mark, without spilling over the brim. Laying the table, they could do correct placement of cutlery and spoons, at appropriate positions.
All this was possible due to Combination of Balance and Co-ordination Exercises given provided stimulation to neuromuscular, proprioceptive, vestibular system along with visual signals helped to create connection between Cerebellum (main center for balance and Co-ordination ) with hippocampus as well as prefrontal and parietal lobe improved cognitive functions such as Spatial orientation, motor planning, memory and navigation skills thus improving the serving skills.
In this study, in Phase 2, a combination of graduated balance exercises on unstable surface along with eye–hand coordinated exercises like walking with trays with bowl filled with water on balancing stones along with coordination activity like fishing rod with magnetic fishes and also the balance exercises was given on the wobble board. Exercises on swiss ball and balance board have been shown to activate muscular contractions strategies differently than the flat surfaces, which is proved on teachers' feedback, thus Balancing exercises given on unstable surfaces like standing on Bolster swing, standing on Bossu ball doing Theraband/Gripper exercises was very beneficial to improve serving skills. These exercises helped to provide stimulation to the neuromuscular structures, vestibular and proprioceptive systems that created synaptic pathways between the Cerebellum, hippocampus. This helped to improve the cognitive functions like spatial functions, motor planning, navigation and memory which are required for serving skills. These challenging exercises with the combination of balance and coordination helped to improve motor planning, spatial orientation, and spatial judgment skills, which are necessary for serving skill. Thus, systematic balance training is capable of enhancing cognitive function, memory, and spatial and cognition structural changes which were been in frontal parietal, memory, and cognition.
This improved their spatial orientation which helped in correct placement of spoons and cutlery, while laying the table and improved their serving skills. Thus, a combination of balance and coordination exercises in the long term showed a significant improvement in speed, agility, and upper limb coordination which is seen in the improvement in serving skills of these special need students.
Sample size was small; hence, the results cannot be generalized to masses. There was no control group to compare the effect of balance and coordination exercise training in normal and special need students.
A randomize intervention control study design can be planed for future research.
| Conclusion|| |
From the present study, it can be concluded that OT intervention exercises given in Phase 1 were effective to enhance postural stability that allowed mobility of fine motor skills with dexterity where the combination of balance and coordination exercise training on unstable given in Phase 2 helped to improve the serving skills of these special need students, as serving skills were the prerequisite of these special need students for placement for their internship in the hotel industry and were incorporated in main stream for functional independence.
I express my sincere gratitude to Ms Fionika Sanghavi, Principal of SP J Sadhana School, for giving me permission to carry on my study. I thank Dr. Punita Solanki, Dr. Renuka Desai, Ms. Vazifdhar, Dr. Snehal, Ms. Smida Corriea, and especially my Daughter Tanvi and Nishant for helping me in my statistical and typing work and my Father for encouraging and motivating me throughout.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Mine U, Gonca B, Kayihan H. Comparison of different therapy approaches in children with downs syndrome. Pediatr Int 2003;45:68.
Gupta S, Rao KB, Kumaran S. Effect of strength and balance training in children with downs syndrome: A randomized controlled trail. Clin Rehabil 2011;25:425-433.
Fotiodou E, Neofotistou KH, Sidiropoulou MP, Tsimaras VK, Mandroukas AK, Angelopoulou NA. The effect of a rhythmic gymnastics program on the dynamic balance ability of individuals with intellectual disability. J. Strength Cond Res 2009;23;2102-2106.
Schoermaker MM, Niemeijer AS, Reynders K. Effectiveness of neuromuscular task training for children with developmental co-ordination disorder: A pilot study. Neural Plast 2003;10:222-228.
Sundaram S. The effect of vestibular stimulation exercises on balance in children with downs syndrome. Univ of Louisville. Electron Theses Dissert Paper 2016;2403:1-42.
Mark A, Kerstin F. Immediate and long term effects of developmental training in children with downs syndrome. Dev Med Child Neurol 1997;19:489-494.
Nahed S, Thabet HM. Modulation of balance and gait in children with Downs's syndrome via gravity force stimulation program training. Bull Fa Ph. Cairo Univ 2011;16:87-92.
Behm DG, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004;36:1397-1402.
Diarmaid F, Nanthana T. Effects of a wobble Board based therapeutic Exergamimg system for Balance training on Dynamic Postural stability and intrinsic motivational level. J Orthop Sports Phys Ther 2011;4:11-19.
Jane BG, Debra MJ. Murphy. Sit-ups and Pushups only - Are we heading for muscular imbalance? J Phys Educ Recreat Dance 1995;66:67-72.
Kibler W, Press J. Sciacca the role of core stability in athletic persons. Sports Med 2006;36:189-198.
Haynes. W. Core stability and unstable platform devices. J Body W Mov Ther 2004;8:88-103.
Ghaeeni S, Bahari Z, Khzaei AA. Effect of core stability training on static balance of the children with down syndrome. Phys Treat 2015;5:49-53.
Bloem B, Allum J, Carpenter M. Is lower leg proprioception essential for triggering human automatic responses? Exp Brain Res 2000;130:375-391.
Steindler R, Kunz K, Schrot F, Scholtz A. Effect of age and sex on maturation of sensory systems and balance control. Dev Med Child Neurol 2006;48:477-482.
Sherll C. Adapted Physical Activity, Recreation and Sports: Cross Disciplinary and Lifespan. New York: WCB MC Graw Hill; 1998.
Schlamminger S, Choi KY, Todd WA, Gundlach JH, Adelberger EG. Test of the equivalence principle using a rotation torsional balance. Phy Rev Lett 2008;100:1101.
Londhe A, Feezandi Z. Comparison of balance and resistive versus balance exercises alone in patients with diabetic neuropathy. Indian J Occup Ther 2012;44:3-9.
Behm DG, Drinkwater EJ, Willardson JM, Cowley PM. The use of instability to train the core musculature. Appl Physiol Nutr Metab 2009;35:91-108.
Clark VM, Burden AM. A 4- week wobble board exercise programme improved muscle onset latency and perceived stability in individuals with a functionally unstable ankle. Phys Ther Sports 2005;6:181-187.
Taube W. Neurophysiological adaptation in response to balance training. German J Sports Med 2012;63:273-277.
Sobhy M, Aly, Asmaa A, Abonour. Effect of Core stability exercises on postural stability in children with down's syndrome. Int J Med Res Health Sci 2016;5:213-222.
Rogge A, Röder B, Zech A, Nagel V, Hollander K, Braumann KM. Balance training improves memory and spatial cognition in healthy adults. Sci Rep 2017;5661.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]