The Effectiveness of Johnston and Ramon Perceptual-Motor Program on Promoting Gross Motor Skills ‎of Children With Visual Impairment: A Randomized Controlled Trial

Introduction: The integration of various senses in the form of perceptual-motor activity is important in different aspects of physical, perceptual, cognitive and psychosocial development. In children with visual impairment, the reduction of visual stimuli will restrict the acquisition of motor skills, including gross motor skills, which affects their perceptual-motor skills. There are few studies on motor activity interventions in these children without specific framework. The purpose of this study is to evaluate the effectiveness of a perceptual-motor intervention based on Johnston and Ramon protocol on gross motor skills of children aged 7-10 years with visual impairment. Methods and analysis: In this randomized controlled trial study, from 140 children aged 7-10 years with visual impairment of blind and low vision schools of Tehran; Narjes for daughters, Khazaeli and Mohebbi for boys, 24 children who had inclusion criteria were randomly assigned 1:1 in two intervention and control groups. The Perceptual-Motor Program was designed based on Johnston and Ramon's protocol and agreed with the agreement of over 75% of the panel of experts that consisted of four members of Occupational Therapy Department of the University of Social Welfare and Rehabilitation Sciences and an optometrist of the Baqiyatallah University of medical sciences. The intervention group received perceptual-motor program for 2 months, three sessions 45 minutes peer weak (24 sessions). The gross motor skills of both groups were measured by the second edition of Movement Assessment Battery for Children (MABC-2); aiming and catching and balance subscales and the second edition of Test of Gross Motor Development (TGMD-2); locomotion and object control subscales in three stages: pre-test, post-test, and one month without any interventions after that for follow-up. Data analysis was performed with Shapiro Wilk, Mann-Whitney, Friedman, Bonferoni and generalized estimating equations and by version 22 of SPSS. The significance level was considered 0.05. Findings: In the intervention and control groups, children with a mean age of 9.2±1.1 and 8.3 ±1.2 were present. The mean and standard deviation of aiming and catching subscale of MABC-2 in the intervention group was estimated to be 4/17±2/82 in the pre-test and 11.17± 1.95 in the post-test and 10.92±1.62 in the Follow-up, but in the control group this number was 3.83±2.79 in the pre-test, 4.25±3.08 and 4.67±2.93 in the post-test and the follow-up. The mean and standard deviation of the intervention group's balance subscale of MABC-2 was 6.25 ± 2.42 in the pre-test, 10±2/13 in the post-test and 9.92 ± 2.19 in the follow-up; whereas changes in the control group were 3.50 ± 3.09 in the pre-test, 3.83 ± 3.46 and 4 ± 3/36 in the post-test and the follow-up. The mean and standard deviation of the intervention group's locomotor subscale of TGMD-2 was 40.92 ± 9.34 in the pre-test, 47.58 ± 1.17 in the post-test and 47.42 ± 1/08 in the follow-up and In the control group, this variable increased from 35.83 ± 12.92 in the pre-test to 36.83 ± 13.17 and 37.67 ± 13.24 in the post-test and the follow-up. The mean and standard deviation of the intervention group's object control subscale of TGMD-2 was 32/50 ±14/74 in the pre-test, 47/50±1/24 in the post-test and 47/66 ± 1/15 in the follow-up; In the control group, this variable was 29.25 ± 12.93 in the pre-test, 30.17 ±12.89 and 30.08 ± 13.34 in the post-test and the follow up. The gross motor skills had a significant increase in the intervention group (p-value<0/05). The MABC-2 subscales (aiming-catching and balance) and TGMD-2 object control subscale were significantly higher than the pre-intervention and the control group (p-value<0/05), which remained one month after the intervention. The TGMD-2 locomotor subscale did not have any significant changes in any of the groups after the intervention (p-value> 0.05). Conclusion: It seems that this perceptual-motor interventional program can be useful in promoting the gross motor skills of children with visual impairment. It is suggested that this program be used in other researches in visually impaired children.