What is Down Syndrome?

Down Syndrome or Trisomy 21 is a chromosomal disorder caused by the presence of all or part of an extra 21st chromosome. Children with Down Syndrome share some physical features:

• Low muscle tone, or “hypotonia” A baby with Down Syndrome feels “floppy” or somewhat like a rag-doll when picked up. The low muscle tone, along with reduced strength and endurance, makes learning gross motor skills harder. Hypotonia is quite easily observed in babies with Down Syndrome.
• Hyper-flexibility
  The ligaments that hold the bones together in the joints of children with Down Syndrome are longer than usual resulting in increased flexibility in joints. This is very noticeable in a child with Down Syndrome’s hips, feet and shoulders. As your child gets older and gains strength and motor control in specific muscle groups, the risks of joint injury lessens.
• Reduced strength
  A child with Down Syndrome does not have to live with the effects of low strength. As with anyone, muscle strength can be improved through exercise. The key is the right kind of exercise, enough repetition and correct exercise performance. It is important to learn the correct way of moving so that poorly coordinated movement does not put strain on ligaments and joints in the long term.
• Short arms and legs
  Compared to the length of their trunks, children with Down Syndrome have short arms and legs. This makes learning certain gross motor skills harder; for example, shorter legs make it harder to climb. Motor skills involving balance, such as learning to sit and to stand, are harder as a child falls further before their hands reach the ground to protect their fall.

Children with Down Syndrome can also have medical issues which affect their physical skills, such as:

• heart problems
• chronic upper respiratory tract infections
• ear infections
• stomach and intestinal problems

All of these can make a child with Down Syndrome tire more easily. 
“Gross Motor Skills in Children with Down Syndrome”, P.Winders (1997)

What Therapies for Kids can do

Babies and Toddlers

Early  paediatric physiotherapy for children with Down syndrome can help with the acquisition of motor skills and develop strength to help maximise motor function and quality of life.  Our team of specialist physiotherapists can :

– promote achievement of gross motor skills such as sitting, crawling and standing
– improve independence in functional activities
– improve muscle strength , posture and balance
– improve confidence  and socialisation with peers through improved motor skills
– reduce the risk of secondary joint problems in later life as a result of lax ligaments
– improve the acquistion of early walking by  treadmill training

Experience of early walking on a treadmill has been shown to help infants with Down Syndrome to walk earlier. [ Treadmill training of infants with Down Syndrome : Evidence +/- based developmental outcomes   Ulrich DA, Ulrich BD ]

At Therapies for Kids we use a medical treadmill to help facilitate walking along with other physiotherapy techniques.

Older Children

For the older child with Down Syndrome our physiotherapists may:

• assist with acquisition of more complex motor skills i.e. bike riding through inclusion in our bike riding groups
• assist with preparation for swimming through hydrotherapy
• suggest treadmill training for strength and endurance

Occupational Therapy for children with Down syndrome can help with the acquisition of fine motor, cognitive and functional (life) skills that will assist to develop your child’s participation and independence and thus improve their quality of life. Our team of specialist occupational therapists can:

Assist development of fine motor skills such as grasping and pinching
Assist to develop play and cognitive skills
Improve participation and independence in functional activities such as dressing and toileting
Improve arm, wrist and hand strength, coordination and control
Improve confidence and socialisation with peers through improved motor skills

Address sensory integration concerns

School readiness / preparedness
Assist with transition to preschool and school
Equipment and environmental modification as required
Cognitive development through play and learning
Develop the required attention skills required for school

What are the language characteristics of children and adolescents with Down Syndrome?

Research and clinical experience demonstrate that some areas of language are generally more difficult for children with Down syndrome while other areas are relatively easier. Children with Down syndrome have strengths in the area of vocabulary and pragmatics (social interactive language). They often develop a rich and varied vocabulary as they mature. They have good social interactive skills and use gestures and facial expressions effectively to help themselves communicate. They generally have the desire to communicate and interact with people. Syntax and morphology (including grammar, verb tenses, word roots, suffixes and prefixes) are more difficult areas, possibly because of their complex and abstract nature. Children with Down syndrome frequently have difficulty with grammar, tenses and word endings and use shorter sentences to communicate.

Most children with Down syndrome are able to understand much more than they can express. As a result, their test scores for receptive language are higher than for expressive language. This is known as the receptive-expressive gap.

Children with Down syndrome learn well through visual means, so often reading and the use of computer programs focusing on language skills can help them learn. Seeing words and images associated with sounds and being able to read words can help speech and language develop. For some children, the written word can provide helpful cues when using expressive language.

What are the speech characteristics of children and adolescents with Down Syndrome?

There are a wide range of abilities that children with Down syndrome demonstrate when using speech. Speech intelligibility (speech that can be easily understood) is one of the most difficult areas for people with Down syndrome at all ages. Many children have difficulty with the strength, timing and coordination of muscle movements for speech. Speech involves coordinating breathing (respiration), voice (phonation), and the production of speech sounds (articulation). Factors that can contribute to speech intelligibility problems include: articulation problems with specific sounds, low oral-facial muscle tone, difficulty with sensory processing and oral tactile feedback, use of phonological processes (e.g. leaving off final sounds in words) and difficulties in motor planning for speech.

What you can do

By providing your child with the opportunity to practice their developing  motor skills in a variety of environments, they will continue to use the skills demonstrated at Therapies for Kids. Providing opportunities to play with their peers in a fun safe environment will maximise their physical development.

By providing your child with the opportunity to practice their developing  motor skills in a variety of environments, they will continue to use the skills demonstrated at Therapies for Kids. Providing opportunities to play with their peers in a fun safe environment will maximise their physical development.

The development of good motor skills allows interaction with their peers in a social setting.  It can be fun to practise skills that develop strength and coordination of your child’s upper limb and these activities can be easily integrated into your everyday routine. Sponges in the bath, squeeze balls in the car and helping hang out the washing are great ways to develop hand and finger strength. Table top activities can be a little harder when pencil paper skills require significant attention and may fatigue your child so your specialist paediatric OT will help provide you with fun ideas and reward strategies for your home program.

Parents can provide practice in speech and language skills at home and in the community. Varied and inclusive home and community experiences help children and adolescents with Down syndrome continue to acquire and use new communication skills. Activities that involve social interaction, such as scouting or participating in youth groups, can help young people with Down syndrome develop and practice speech and language skills. When a child has more opportunities to communicate, his or her skills will expand.