title: Cross-sectional study of motor development among children after the Fontan procedure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Ontario, Canada. plongmuir@cheo.on.ca
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Longmuir
authors.forename: Laura
authors.initials: L
authors.lastname: Banks
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D061725:Accelerometry; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000503:physiopathology*; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008124:Locomotion; D008297:Male; D009043:Motor Activity; D009048:Motor Skills; D057185:Sedentary Behavior