All kids generally want to do the same things – lift their heads, sit, crawl, stand and walk.
But children with Down’s syndrome (DS) have some physical limitations that affect their movements. Oftentimes, when they try to do the same activities as everyone else, they develop wrong movement patterns to compensate for their weaknesses or physical limitations.
That can lead to lifelong pain, altered movement patterns, and extra stress on bones and joints.
When kids with DS find it difficult to move, they stop engaging in physical activity. That puts them at risk for secondary conditions such as obesity, diabetes, Alzheimer’s and psychological issues later in life. (Reference)
Physical therapy can help manage most of the functional issues that kids with Down’s syndrome face from infancy.
In this article, we’ll talk about different areas that physical therapists can work on and how they can help kids lead healthier lives.
How Are the Bodies of Kids With Down’s Syndrome Different?
Kids with Down’s syndrome have multiple physical traits that make them stand out from their non-DS peers. They have eyes that are slanting upwards, flatter noses, shorter necks, ears of a different shape and so on.
But here, we’ll only discuss those that change their functional movements:
- Wide feet
- Smaller hands
- Shorter arms and legs
- Abnormal pelvis
- Hypotonia (decreased muscle tone)
- Decreased muscle strength
- Smaller stature
- Hyper flexible joints
The shorter arms and legs, amongst other reasons, affect balance. Their smaller hands make it challenging for them to perform activities of daily living using the same tools and utensils that other people use.
Decreased muscle tone causes the bodies of kids with Down’s syndrome to be floppy. Wide feet with a reduced arch make it difficult for them to stand and later lead to foot and ankle problems.
Physiotherapist’s Role in the Management of Downs Syndrome
Physiotherapists are experts in helping you optimize your movement patterns and avoid injury. For kids with Down’s syndrome, a physio’s job is to work on gross motor skills and help them achieve developmental milestones.
The PT treatment for kids with Down’s syndrome begins with an assessment.
Here, the physical therapist will check which, if any, milestones the kid has achieved. Then, they’ll assess if any of their current movement patterns need work.
If a kid with Down’s syndrome has adapted a compensatory pattern, that’ll need to be addressed before working on anything further. If everything seems good, the physio will start helping the kid with Down’s syndrome achieve their next milestone.
For example, if your kid can sit independently at the time of your first visit to the PT clinic, your physiotherapist will then check your kid’s sitting posture, and if it’s correct, start working on helping your kid crawl.
Similarly, if he can stand, the next step will be to help your kid walk.
PT can help manage many of the functional issues associated with DS. The main areas covered in physiotherapy for kids with Down’s syndrome include:
1. Balance and Falls
Balance is often the first thing physiotherapists start working on kids with Down’s syndrome. That includes sitting, standing and walking balance.
Sitting balance can be decreased due to floppiness. Standing and walking balance tend to be compromised due to
- Hyper flexibility of the joints
- Wider stance (kids with Down’s syndrome stand with feet wide apart and not under the hip)
- Lower muscle tone
- Decreased muscle strength. Balance becomes affected because the postural/stability muscles are weak.
- Fewer balance reflexes due to a smaller cerebellum (part of the brain that controls balance)
- Sensory processing deficits are also responsible for falls and clumsiness.
Slow reaction time also indirectly contributes to balance issues. Because when the kid feels unstable, it takes them longer to realize that they should hold on to something or move a certain way to regain their balance.
That can delay their independent sitting, standing and walking milestones.
Physical Therapy Exercises to Improve Balance in Kids With Down’s Syndrome
The simplest exercise physiotherapists often start with is tummy time. It develops strength against gravity and indirectly improves balance. (Reference)
Physioball, or gym ball, is also great for improving balance. The physiotherapist can sit the kid down on the ball and challenge their balance by moving the ball as the kid tries to maintain their position.
Your physiotherapist might stand the kid next to a walker or advise you to do the same with furniture around the house. While the kid stands, the physio will adjust their feet, knees and back to train a correct upright posture.
Walking on a treadmill is excellent for correcting walking posture. The physiotherapist will support the kid so that he doesn’t fall.
Often kids with Down’s syndrome walk with feet wide apart and stiff knees. Treadmill walking under supervision allows physiotherapists to help the kids develop the correct walking pattern.
It’s preferred that kids walk with minimal support. Active movement encourages brain-body coordination. (Reference)
Stair climbing can help improve balance since it challenges a single-leg stance.
2. Posture
When kids with Down’s syndrome sit, they tend to fall forward and sit with a hunched back and neck bending backwards.
Physiotherapists provide support at different levels to cue a child with Down’s syndrome to sit properly. Similarly, they can use braces for the torso and lower back to stimulate kids to activate the correct postural muscles to support themselves.
3. Strength and Conditioning
Physiotherapists use exercises to overcome decreased muscle tone and muscle strength. They often disguise exercises in the form of play (also known as perceptual-motor therapy). (Reference)
So a physio might encourage the kid with Down’s syndrome to explore their environment which has a bunch of toys and slightly irregular walking surfaces to challenge them.
During this process, you may find that your kid naturally gravitates towards a specific activity or sport. You should double down on that and make exercising fun for them.
Physios work on overall muscle strengthening by playing catch with kids, encouraging them to throw the ball farther, kicking a ball and jumping. Some kids also respond to training with a resistance band and strengthening the body that way.
Bicycle riding is another activity that works on muscles of the entire lower limb and the torso. (Reference)
4. Fitness and Preventive Health Measures
Physiotherapists can prescribe a safe exercise regimen for kids with Down’s syndrome. Since such kids are at risk for obesity, early physical therapy interventions can lead to a healthier lifestyle as adults.
They can also design exercises for general fitness and prevention of secondary complications of Down’s syndrome.
How Does Physical Therapy Help Kids With Down’s Syndrome?
Physical therapy helps kids with Down’s syndrome achieve their milestones sooner.
It teaches them the correct postures for everyday activities and gives them the freedom to be functionally independent.
Moreover, PT helps kids with Down’s syndrome in the following ways:
- Reduces the risk of secondary conditions such as obesity and osteoarthritis
- Improves muscle strength (Reference)
- Improves balance
- Normalize muscle tone
- Develops core strength
- Makes joints more stable
- Improves overall gross motor skills such as sitting, crawling, walking, running, stair climbing and so on.
- Leads to better cardiovascular health (Reference)
The Takeaway
Although physical therapy for kids with Down’s syndrome produces excellent results, not everyone needs it.
You have to know what your kid’s baseline is and what they need help with. PT interventions are personalized for each patient. The same treatments aren’t prescribed to all patients.
All the various limitations that kids with Down’s syndrome face, such as decreased muscle strength and hypermobile joints, can be overcome with consistent efforts from the kids’ side along with effective physical therapy interventions.
But it’s important for parents to know not to rush their kids to achieve developmental milestones. Kids work on their own timetable. You need to listen to what they want and follow their cues.
PT is advisable because it can help kids learn the correct movement patterns and do those without hurting themselves or being discouraged to move.
If you need more information on how physical therapy helps kids with Down’s syndrome, feel free to contact us.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.