Occupational Therapy for Down Syndrome

Role of occupational therapy in down syndrome-

What is Down syndrome?

Down syndrome is a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21. Down syndrome is a naturally occurring chromosomal arrangement that has always been a part of the human condition, being universally present across racial, gender or socio-economic lines, and affects approximately one in 800 births worldwide. Down syndrome is a condition that is present at birth, which affects the body’s physical and mental development.

Normally, a child inherits two copies of chromosome 21 – one from each parent. If a child inherits an extra chromosome 21, the child will have Down syndrome. Because Down syndrome usually affects every cell in the body, people can have a variety of medical problems.

Common Features-

While no two children with Down syndrome are exactly alike, they do share some common physical features. Babies with Down syndrome have similar facial features, tend to have lower muscle tone, and typically learn to walk and talk slightly later than other children.

Children with Down syndrome have a distinct facial appearance. Though not all children with Down syndrome have the same features, some of the more common features are:-

● A slightly small head that is flattened in the back;
● Up-slanted eyes;
● Extra skin folds at the inner corners of the eyes;
● Small ears, nose and mouth;
● Short stature;
● Small hands and feet…and
● Some degree of intellectual disability.

Treatment of down syndrome-
Down’s Syndrome cannot be cured. There is no medicine or treatment that can eliminate the existence of the extra chromosome. However, it has now been found that early intervention and training in fields of speech and play can help these children to become independent in daily life skills.

Early intervention is systematic program of therapy, exercises, and activities designed to address developmental delays that may be experienced by children with Down syndrome – with the goal of enhancing the development of infants and toddlers and helping families understand and meet the needs of their children. The most common early intervention services for babies with Down syndrome are physical therapy, speech therapy, and occupational therapy.

Down syndrome and Occupational therapy

Children with Down syndrome want to do what all children want to do, they want to sit, crawl, walk, explore their environment, and interact with the people around them. To do that, they need to develop their gross motor skills. Because of certain physical characteristics, which include hypotonia (low muscle tone), ligamentous laxity (looseness of the ligaments that causes increased flexibility in the joints) and decreased strength, children with Down syndrome don’t develop motor skills in the same way that the typically-developing child does.

Motor development is a core issue in the development of every child. And children with down syndrome generally lack in the motor development.

Infants with down syndrome typically have central hypotonia (floppiness without weakness) and, as a consequence, gross motor skills are delayed. Most children with down syndrome do not sit up until 1 year of age or walk until 2 years (Melyn & White, 1973).

The Goal of occupational therapy for these children is not to accelerate the rate of their development, as is often presumed, but to facilitate the development of optimal movement patterns. This means that over the long term, therapist want to help the child develop good posture, proper foot alignment, an efficient walking pattern, and a good physical foundation for fine motor skills, and activities of daily living.

When the down syndrome child is an infant, parents immediate concerns relate to his/her health and growth, development of the basic motor milestones, social interaction with parents and others, interest in things going on around him/her, and early speech sounds and responses.

Early Intervention for down syndrome child –

• Assist with oral-motor feeding problems (this can also be addressed by Speech therapist). Due to hypotonia and weakness of the muscles of the cheeks, tongue, and lips, feeding is difficult for some infants with Down syndrome. OT suggests positioning and feeding techniques.
• Help facilitate motor milestones, particularly for fine motor skills. Occupational therapists and Physical therapists work closely together to help the young child develop gross motor milestones (eg: sitting, crawling, standing, and walking). Occupational therapist works with the child at this stage to promote arm and hand movements that lay the foundation for later developing fine motor skills. The low muscle tone and loose ligaments at the joints associated with Down syndrome are real challenges to early motor development and occupational therapy can help the child meet those challenges.

Most children with Down syndrome learn to speak and will use speech as their primary means of communication, they will understand language and have the desire to communicate well before they are able to speak. Total communication, using sign language, pictures can serve as a transitional communication system. Parents are the primary communicators interacting with their babies and young children; thus, parents can do a great deal to help their children learn to communicate. Many of pre-speech and pre-language skills are best learned in the home environment.

Occupational therapy Assessment in down syndrome child-

The child with down syndrome delays in gross motor skills, fine motor skills, cognitive skills, and communication.

OT assesses all areas of development (gross motor skills, fine motor skills, behavior, social skills, cognition and perception) for comprehensive management planning.

OT may use different formal or informal tests to assess down syndrome child.

OT checks following sensorimotor components-

• Muscle tone
• Muscle strength
• Muscle endurance
• Range of motion
• Coordination and balance
• Posture
• Hand function.

Cognitive and perceptual component it includes-

• Attention
• Memory
• Figure-ground
• Directionality

Social components-

• Social smile
• Peer relationship
• Group interaction

Behavior Tantrums and Communication (verbal & non verbal).

Occupational therapy intervention for down syndrome-

Occupational therapist plan out the intervention strategies depending on the issues with the specific down syndrome kid. Occupational therapist takes different functional activities to promote function in the down syndrome child.

Activities use by the OT is more of a play kind and functional. OT provides early intervention services to the infant and toddlers having down syndrome.

Occupational therapy involves activities in the approaches like neurodevelopmental therapy, sensory integration, and behavior therapy.

Neuro Developmental Therapy (NDT) –

NDT looks in the sensorimotor component of a child. NDT along with functional activities for the down syndrome works best.

If the child lacks the early developmental milestones, OT focuses on these areas. It includes-

• Proper handling techniques
• Facilitation of active movements and inhibition of unwanted movements.
• Improve reach and grasp for functional play.
• Weight bearing and weight shifting techniques.
• Positioning and adaptive equipment.

Sensory Integration (SI)-

The down syndrome children may have sensory issues such as tactile, proprioceptive, vestibular/ balancing issues. Occupational therapist use principles of sensory integration to treat sensory issues.

Sensory integration approach helps the down syndrome child to regulate arousal level. It also improves the ability to attend the task.

Sensory integration activities may include-

• balancing activities (e.g. bouncing, swinging, spinning)
• Tactile activities (e.g. brushing, massaging, play doh)
• Oral motor activities (e.g. blowing, drink from a straw, chewing)

Read More…. Sensory Integration

Behavior Therapy –

The down syndrome kids may show stubbornness and haughtiness. They avoid some activity and through tantrums. Behavior strategies like positive or negative reinforcement can be applied to cut down their behavior issues.

Read More… Behavior Therapy

Activities of Daily living (ADL)- 

The down syndrome kids may lack ADL skills and dependent on parents for daily routine tasks. Occupational therapist tries to make them independent as much as possible.

ADL board can be helpful to teach them ADL skills.

Occupational therapy activities for down syndrome children-

Gross Motor Activities-

• Jumping on the trampoline.
• Walking on the balance beam with or without support.
• Obstacle activities
• Balance board activity- ask him to clap up and down, front and back (for laterality concept and direction).
• Ball catching-throwing while balancing on the balance board.
• Ask him/her to grab an object from opposite side’s hand on bolster swing (midline crossing, reach out, core muscle activation).
• Wheelbarrow walking to improves the strength of upper extremity.
• Ladder (static/dynamic) climbing for eye-hand and hand-leg coordination.

Fine Motor Activities –

• Theraband activities (Push-Pull).
• Theraputty activities.
• Dynamic sand.
• Pegboard activity.
• Elastic bands.
• Tongs for pre-scissors skills.
• Paper cutting, pasting.

Tips for parents with Down’s syndrome child –

Down’s syndrome has no cure, but the medical complications associated with Down syndrome can be treated and managed. Treatment for Down syndrome is specific to an individual’s needs. So, it’s very important for parents to understand the basics of good parenting skill for handling a special child. Here we have mentioned few but important tips for parents.

#1 Accept the fact-
Accept the reality as it is. Your child has some disability- it might be physical or learning or any other. But having a disability does not mean he/she is a burden to the society. Acceptance of the fact will enable you to reach for a better and precise action. Never hide the fact, it’s never an embarrassment nor a curse.

Keep high degree of patience, conviction, and commitment. It takes years to bring the child up. It is an ongoing process, thus enjoy every bit of it. Next, leave no stone upturned, listen to all, try everything but take your own decision.

#2 Teach to love and be loved- 
Children are innocent and calls for pure love. If you do not love your child, he/she will never love himself/herself. Spend quality time with your child.

#3 Be positive–
Some actors like Chris burke, Tommy Jessop, Lauren Potter in Hollywood movies have proved themselves. Children with down syndrome are the part of this world and do anything. Just they need some support from parents. So be positive and do your best for these kids.

#4 Involve them actively-

Involve them in a daily routine task. Help them initially and provide the cues if necessary.

#5 Identify talent and channelize it–
Never thrust your wishes on the child. Encourage his/her strengths. Do not try to become the controller of his/her destiny. Remember the child is a differently abled child.

Be his/her friend, guide, and facilitator. Remember, every child is gifted with some talents. Identification of talents is difficult but necessary.

#6 Hide your stress-
Learn to hide your pressure and stress. Never let the child develop a feeling that the parents are in deep trouble. TRUST that no one else can be as focused for his/her welfare as his/her parents, so be cool and have energy for him/her always.

#7 Last but not the least – Never Give up.

References –

1. Mark Batshaw. Children with disabilities.4^th Maclennan+petty publication.
2. Maryanne Bruni. Fine motor skills for children with down syndrome: a guide for parents and professionals.(2016). 3^rd Woodbine House publication.
3. Patricia Winders. Gross motor skills for children with down syndrome: a guide for parents and professionals.(2013). 2^nd Woodbine House publication.