down syndrome Flashcards
jumping forward
most by 5-6 yrs
climbing step
most by 5-6 years
running
most by 6 yr
walking
most by 2.5 yrs
standing
most by 2 yrs
crawling
most by 2 yrs
sitting
most by 1 yr
rolling
most after 6 months
at 18 months
most children are working on floor mobility and sitting skills
at 18-36 months
standing and walking are primary focus
3-6 years
walking, running, jumping
down syndrome
most common chromosomal condition
1 In 700 births
incidence increases as maternal age increases
prenatal screen at 10 and 14 weeks
presentation
hypotonia
small hear, ears, mouth
epicentral folds
flat nasal bridge
upward slanting palpebral fissures
co morbid conditions
neurological - cognitive disability
MSK - Atlanto-occipital laxity
CVD/P - approx 50% have congenital heart defects
pulmonary obstructive sleep apnea - between 3-4 yrs sleep study
Atlanto-occipital laxity
15% incidence, only 2% develop symptoms of cord compression which rarely leads to paralysis
Symptoms may include difficulty walking, abnormal gait, neck pain, easy fatigability, limited neck mobility, torticollis, change in hand function, sensory impairment, onset of spasticity
Screening controversial
body function and structure movement chracteristics
hypotonia
postural control
strength
skeletal alignment
activity and participation movement characteristics
delayed motor skill development
PA
participation restrictions
adaptive behavior
tests and measures
GMFM
6 min walk
TUG
TU down stairs
PBS
Funfitness
posture and observational analysis
PT goals
In general, PT goals are to enhance the acquisition rate of motor skills and prevent occurrence of secondary problems resulting from compensatory strategies to overcome hypotonia and joint instability.
Co-create with family and child
Consider child’s and family’s physical activity preferences
Use gross motor curves to communicate with parents about developmental progress and expectations about attaining specific gross motor skills
early intervention
Tummy time (Wentz 2017)
Sensorimotor therapy
Lower extremity orthotic intervention
Onset of independent walking unless excessive pronation leads to standing in poor alignment
Treadmill training- 0.2 m/s for 8 min/day, 5 days/week (Abdel 2010)
motor learning considerations
Task-specific practice
Increased repetitions
Limit verbal cues and increase visual feedback or modeling
Slow movements when modeling to accommodate slower cognitive processi
PT interventions > 3 yo
Strength
Postural control
Whole-body vibration
Orthoses (SMOs or FOs)
Aerobic training
Physical activity (eg, bike riding, dance)
Jump training (eg, trampolines, hopscotch)
Bike riding (MacDonald, 2012)
Hippotherapy (confirmed AO instability is a contraindication)
Increase parent involvement with HEPs
transition to adulthood
Transition planning begins at 16 yrs
Life expectancy ~60 years
Primary concern – mental health
30% of adults with DS have depression
>50% have Alzheimer disease for adults 50+ yrs with DS
Obesity
Orthopedic conditions (eg, osteoporosis, degenerative joint disease)
key takeaways
Down syndrome is a highly variable diagnosis with multisystem involvement
Common impairments include hypotonia, ligamentous laxity, inefficient postural control, and cognitive deficits
Goals may be informed by the established motor growth curves
PT intervention decision-making should be individualized and in-line with each child and family’s personal movement goals
