Children with Down syndrome typically display low muscle tone, or hypotonia, in varying degrees, as well as ligamentous laxity, or loose ligaments, and muscle weakness. These issues can cause delays in motor development, with children achieving developmental milestones, such as rolling over, sitting, standing and walking, later than typically developing peers. Posture can be affected, as can balance and gait, placing undue stress on the body's joints. The goal of physical therapy in youngsters with Down syndrome is to encourage correct body posture and promote efficient body mechanics to reduce injury risk and increase strength and endurance.
Sitting Posture
Among the goals of physical therapy for a 4-year-old with Down syndrome is proper sitting posture. Low muscle tone and weak muscles contribute to a common issue, postural kyphosis, which is often first noticed when a child learns to sit. This is characterized by a pelvic tilt, rounded back and the head resting on the shoulders. Physical therapists will generally make addressing this issue a priority if it is present in toddlers, since if this posture is not corrected it can lead to back pain as well as breathing and trunk rotation impairments over time.
Standing Posture
Many children with Down syndrome compensate for joint instability caused by loose tendons, low muscle tone and weak muscles by adopting poor posture habits, which can lead to joint problems later in life. This compensatory posture is typically characterized by a wide-legged stance with knees locked and feet turned out, a stance that widens their base, providing a feeling of stability. Proper standing posture is often on the short list of physical therapy goals for preschoolers.
Gait
That wide-legged stance while standing frequently carries over into a child's gait, resulting in poor body mechanics while walking or running. Children adapt to underlying instability and weakness in the legs by walking with feet wide apart and turned outward and knees stiff, a posture that makes them feel more stable. However, this type of gait can cause problems with the feet and knees over time and is very inefficient, causing the child to tire more easily. Correcting this posture in toddlers before it becomes an ingrained habit is typically a priority in physical therapy programs for children with Down syndrome.
Considerations
While the goals mentioned are commonly included in a physical therapy plan for 4-year-olds with Down syndrome, each child is different, so physical therapy goals will differ from one child to another. Physical therapists typically evaluate each child's abilities to tailor physical therapy goals to meet each child's individual needs, enabling them to build on strengths and effectively address weaknesses.
References
- PediaStaff; The Goal and Opportunity of Physical Therapy for Children with Down Syndrome; Patricia C. Winders, PT; December 2010
- Down Syndrome Education; Motor Development for Individuals With Down Syndrome; Ben Sacks and Sue Buckley
- American Academy of Orthopaedic Surgeons; Kyphosis (Roundback) of the Spine; September 2007
- BabyCenter: What Is "Low Muscle Tone" and What Does It Mean?
