physical therapy for children with down syndrome · down syndrome is: • to achieve gross motor...
TRANSCRIPT
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Physical
Therapy for
Children with
Down SyndromePatricia C. Winders, PT
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What we will cover:
1. Goal of physical therapy
2. Physical factors that impact the development of gross motor skills
3. Compensations for these factors
4. Crucial Components to develop when learning gross motor skills
5. Examples of how physical therapy addresses learning gross motor skills to help develop the crucial components
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What is the goal of physical therapy
for children with Down syndrome?
What is the Big Picture?
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The goal of physical therapy for children
with Down syndrome is not:
To try to achieve gross motor skills more quickly
(to accelerate the rate of gross motor
development)
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The goal of physical therapy for children with
Down syndrome is:
• To achieve gross motor skills in a way that the child develops the crucial components
• The goal is to lay the foundation for a functional body so the child can do what he wants to do throughout his life
• To focus on the long term perspective (what is needed as an adolescent and adult)
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Physical factors that impact the development of
gross motor skills:
• Hypotonia
• Ligamentous laxity
• Decreased strength
• Short arms and legs
• Medical problems
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Compensations for the physical factors
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Crucial components to develop when
learning gross motor skills
1. Upright head and trunk
posture
2. Shoulder posture
3. Weight shifting/Balance
(later in life)
4. Optimal alignment of
hips, knees, and
ankles that support
standing and walking
skills
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The Critical Periods for Physical Therapy
1. The Birth to Walking Period
2. The Post Walking Period
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Stage 2
1. Supine
• Reach, hand to foot play, bridge position
2. Prone
• Propping on elbows & hands, reaching
3. Pull to sit & Sitting
4. Supported kneeling
5. Rolling
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How physical therapy addresses learning gross
motor skills to develop the crucial components
We will look at 4 examples:
• Sitting
• Moving into sitting
• Learning to stand with an optimal posture
• Walking
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Learning
to sit
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Moving into sitting
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Learning to stand
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Optimal standing posture
• Narrow base (feet
2-3 inches apart)
• Feet and knees
point straight ahead
• Heels against the
bench
• Pelvis over the
bench
• Mild knee bending
• Hold my thumbs
• Activate abdominals
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Initial Walking Pattern
• Wide base
• Toeing-out
• Full sole weight bearing, with weight on the medial borders of the feet
• No pelvic rotation
• Short step length
• Stiff knees
• Inactive ankles
• Arms in high guard
Walking
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• Narrow base
• Knees and feet point straight
ahead
• Rotation of pelvis
• Long step length
• Mild knee bending
• Optimal foot alignment
• Heel-toe pattern, weight
shifting from heels to balls of
feet
• Hip hyperextension
• Speed and endurance
The Post Walking Period:
The goal is to refine the walking pattern
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Optimizing the walking pattern is
accomplished by:
• Practicing post walking skills to improve
specific movement patterns (especially
running)
• Foot Management
• Using an athletic shoe with a
flexible sole
• Providing adequate support in the
shoe
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Evaluate the foot posture
when standing and walkingDetermine if support is needed
and when needed
•From the front:
• Feet point straight or
turn out?
•From the back:
• Narrow base (with
heels in line with hips)
or wide base?
• Heels tilted or
vertical?
•From the side:
• Is there an arch or is
the arch collapsed and
flat?
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Pronation
Back view
(heel tilt)
Side view
(Flat arch)
Front view
(Toeing-out)
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Cascade dafo HotDog Inserts*add foam filling to arch
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Athletic Shoe • Very flexible in
toe-box area
• Lightweight
• Broad rounded toe box
• Lace closure
• Firm heel counter with
extension
• Firm medial counter
• Sole: flared at heel
(back view: wider where
base contacts ground
than under heel)
• Not high top
• Remove insole
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Conclusion
The goal is to develop the crucial components,
not to achieve gross motor skills more quickly.
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ReferencesBull, M. J. (2011). American Academy of Pediatrics Committee on
Genetics. Clinical Report-Health Supervision for Children with Down
syndrome. Pediatrics, 128, 393-406.
Weber, A., & Martin, K. (2014). Efficacy of Orthoses for Children with
Hypotonia: A Systematic Review. Pediatr Phys Ther, 26, 38-47.
Winders, P. C. (2014). Gross Motor Skills for Children with Down
Syndrome: A Guide for Parents and Professionals (Second Edition).
Bethesda, MD: Woodbine House Inc.
Winders, P. (2018). A Schedule of Gross Motor Development for
Children with Down syndrome. Journal of Intellectual Disability
Research (submitted for publication).