Upside of Down. How can physiotherapy help?
As part of Down Syndrome awareness day, we have decided to discuss the role of Physiotherapy in Down Syndrome.
The first few years following the birth of your child who has been diagnosed with down syndrome can be tricky not just for your child but for you as well. One factor to consider is the realisation that your child might find it difficult to reach the same developmental milestones as quickly as children of similar age.
Developmental delay is commonly associated with children with Down Syndrome and can be a hurdle for both parents and their child. Physiotherapists may be able to give you a helping hand through that journey and we at the Back & Body clinic would love to help out where we can to guide you through this adventure.
As you will know children with Down Syndrome are born with some specific characteristics some can be helped with physio and some can’t. Here are the characteristics which we can help with:
- Hypotonia (low muscle tone)
- Increased flexibility (due to increased laxity in their ligaments)
- Reduced balance (due to having shorter arms and legs)
- Decreased muscle strength (affecting fluidity of movement)
So…. what’s the physio’s role:
Physiotherapy aims to address any developmental issues that might arise. Delays vary on an individual basis however, research has shown that the earlier you can seek advice on positioning and activity ideas the better. This will help to promote developmental skills such as rolling, sitting, crawling and walking. The physiotherapist will assess your child and give recommendations on how to help support your child’s posture as well as give strategies and treatment to help facilitate movement and make movement easier. This will also prevent them from developing compensatory movement patterns that can be problematic later in life.
1. Hypotonia (low muscle tone)
For a child with hypotonia, you might notice when you pick your child up that sometimes they slip between your hands, or they may be described as “floppy”.
The difficulty is, that if you have slightly reduced muscle tone, it makes it much harder to initiate movement, which is commonly why children with Down Syndrome have associated developmental delays. It’s harder for them to initiate the movements needed to roll over, crawl and walk therefore it takes them a little bit longer to learn.
2.Their increased flexibility (due to increased laxity in their ligaments)
Due to having increased laxity around their joints children with Down Syndrome are often extra flexible, this can make them feel unstable in sitting and standing. The ligaments that support the bones are slacker and therefore allow more movement which makes it difficult to balance. As a result, children will commonly adopt postures that take up a wide base of support to compensate.
This increased flexibility can make early developmental skills such as crawling and standing difficult. A physiotherapist will help facilitate your child into positions that at first will make them work harder but this will teach them how to use their muscles properly.
3. Reduced balance (due to having shorter arms and legs)
Having shorter arms and legs in comparison to their trunk can make developmental skills such as sitting difficult. This is because children are unable to rely on using their arms to prop them up in the same fashion than a child who is typically developing would, therefore common compensatory techniques are learnt to overcome this which is great at the time of achieving the task, however can cause problems further down the line (such as knee and back pain). A physiotherapist can help your child develop gross motor skills such as sitting and walking, without them learning to rely on compensatory movements to achieve the task.
4.Decreased muscle strength (affecting fluidity of movement)
Reduced muscle strength will impact the fluidity and ease at which a movement is performed. Strength can be significantly improved through practice and repetition of movements in the right movement plane which is important to avoid the development of compensatory movement patterns. The physiotherapist will demonstrate and advise on play positions to help strengthen up weaker muscles (commonly around the hips and shoulders) to enhance their independence and function. They may recommend a block of treatment to work towards specific goals and will use facilitation to help assist your child in working muscles that are weaker.
TheraTogs is a useful tool that a physiotherapist may recommend using in conjunction with their therapy. TheraTogs is a therapeutic garment used to increase stability and help give proprioceptive feedback to the client. Specific strapping is used to help improve the alignment of the spine and pelvis to prevent the development of compensatory movement patterns and to encourage movement within a functional and well-aligned movement pattern.
Examples of compensatory movement patterns:
- Walking with feet turned out
- Standing in a lordotic (stomach out and back arched) posture
- Sitting with their back rounded
- Sitting with legs stretched out really wide/ Lying in “frog-legged posture”
Examples of common positions you might find your child rests in and what you can do to help…
- Star fish posture
- Frog legged posture
Due to a combination of increased laxity at joints and increased hypotonia, children with Down Syndrome also often adopt postures which allow them to take up as much of their base of support as possible.
So, when lying on their back children with low tone often adopt a “star fish” posture – they’re taking up as much of their base of support as possible because anything else takes a lot more effort. This lack of muscle tone makes it difficult for them to actively lift their arms up to play with their play-mobile, for example.
What to do? By rolling up a towel in a sausage shape and placing it under your child’s shoulders you are giving them a little bit of added support, which ultimately will help them to not only maintain a more functional position, but it will also support them in achieving the task of reaching up for their toys.
Additionally, if your child likes to adopt the famous “frog-legged” posture, by using the towel trick around their hips it’ll give them the added support they require to hold their hips in a neutral position whilst also helping to develop the strength needed later-on for crawling and walking.
The more they practice a task successfully, the more muscle strength they’re building up and will be able to reach their developmental goals successfully.