Down's Syndrome is a genetic disorder that occurs during development. In normal development 23 chromosomes are produced, however in a child with Down's Syndrome an extra chromosome is formed (under chromosome 21) and this is thought to be the cause of the condition.

It is diagnosed mainly during childhood and is noticeable through the facial characteristics that are common with the condition. However screening tests during pregnancy can indicate the likelihood of your child being born with Down's Syndrome.

PROBLEMS ASSOCIATED WITH THIS CONDITION

Down's Syndrome is typically characterised by facial features such as eyes that slant upwards and outwards, a round shaped face, a small nose and a flat nasal bridge. Down's Syndrome often results in the following difficulties:

• Reduced muscle tone
• Hyper-flexibility
• Muscle weakness
• Poor grip
• Poor handwriting
• Co-ordination difficulties
• Delayed development in fine and gross motor skills

HOW CAN THESE DIFFICULTIES IMPACT ON FUNCTION?

Children with Down's Syndrome often have profound learning difficulties that impact upon function at home, in school and socially. The level of the learning disabilities will depend on the child, varying from profound to mild. Some of these difficulties are listed below:

Home:

• Delayed milestones
• Rolling, sitting, sit to stand, grasping objects, passing objects from one hand to another and various other milestones are delayed due to Down's Syndrome.
• Behavioural issues with siblings
• Poor grip
• Difficulty carrying food, drink through the house without spilling it

School:

• Learning difficulties
• Concentration difficulties
• Understanding abstract concepts

Social/behavioural:

• Bullying
• Isolated, lack of friends

OCCUPATIONAL THERAPY TREATMENT AVAILABLE

An occupational therapist can provide effective treatment and management of the symptoms of Down's Syndrome and offer advice and support to the parents of a child with the condition. Treatment could involve the following:

• Fine motor improvement therapy
• Gross motor activity training
• Home or school visit
• Improved handwriting
• Improved social skills
• Improved grip and skills involving carrying objects
• Increased independence in getting dressed and planning their day

PHYSIOTHERAPY TREATMENT AVAILABLE

Physiotherapy should be started early (preferably from birth) to reduce impact of weakness and laxity on later life and help prevent some disfiguration. The main aim of a physiotherapy programme is to improve quality of life and promote normal development. This will be achieved through providing help and support throughout the life of a person with Down’s syndrome in order maintain health, and prevent deterioration.

Down’s syndrome can affect a person both physically and mentally, therefore a person with Down’s syndrome is likely to a combination of physical difficulties, with associated learning difficulties. This combination means development is often delayed.

Some characteristics of Down’s syndrome have little or no effect on the everyday lives of the individuals, whereas others can significantly hinder development and the learning of motor skills.

Above: Foot and ankle mobilisation and stretch exercises by a paediatric physiotherapist

Physical symptoms that may affect physical ability, and cause difficulty in everyday activities such as sitting, climbing and reaching include:

• shorter limbs
• poor muscle tone
• ligament laxity
• muscular weakness

These physical changes can result in functional difficulties such as:

• decreased head control
• poor posture in sitting and standing
• altered gait (walking technique)
• reduced co-ordination

The associated learning difficulty often causes a barrier for the acquisition of motor skills, both gross (large movements) and fine (small movements). Often this barrier is communication based.

Physiotherapy can include a number of techniques to promote full and independent living; these may include;

• practice of motor skills – both gross (large movements) and fine (small movements)
• exercises to strengthen specific muscle groups
• proprioceptive training to improve ligamentous awareness and decrease ligament laxity
• exercises to improve range of movement
• guidance and exercises to promote correct movement patterns, these may be modified to match physical capabilities

HOW CAN PHYSIOTHERAPY HELP PEOPLE WITH DOWN'S SYNDROME?

Physiotherapy should be started early (preferably from birth) to reduce impact of weakness and laxity on later life and help prevent some disfiguration. The main aim of a physiotherapy programme is to improve quality of life and promote normal development. This will be achieved through providing help and support throughout the life of a person with Down’s syndrome in order maintain health, and prevent deterioration.

Physiotherapy can include a number of techniques to promote full and independent living; these may include:

• practice of motor skills – both gross (large movements) and fine (small movements)
• exercises to strengthen specific muscle groups
• proprioceptive training to improve ligamentous awareness and decrease ligament laxity
• exercises to improve range of movement
• guidance and exercises to promote correct movement patterns, these may be modified to match physical capabilities

Physiotherapy provides help and support to optimise the chances of a full and independent life. As well as helping to achieve developmental milestones, physiotherapy is also able to provide various other benefits:

• Improved head control
• Improved strength
• Improved coordination
• Mechanisms to enable one to better cope with the functional demands of everyday life
• psychological wellbeing

SPEECH THERAPY TREATMENT AVAILABLE

Speech and language therapists play an important role in the treatment of individuals with Down syndrome. Speech and language therapy improves, supports and develops speech, language and communication skills. Speech and language therapy additionally helps any difficulties the individual may have with eating, drinking and swallowing.

Many individuals with Down syndrome will experience speech and language difficulties that will lead to impaired communication skills. Individuals with Down syndrome will often have difficulty producing certain speech sounds, with some speech being difficult for others to understand. Children with Down syndrome commonly have delayed speech, language and communication skills in comparison to their typically developing peers. Children with Down syndrome are often very social and use their non-verbal skills (facial expression, gesture and body language) for longer than other children of the same age.

Speech and language therapists will work on a number of areas of speech, language and communication and will aim to:

• Improve oral motor skills
• Develop eating and drinking skills
• Develop emerging language skills
• Improve and develop speech sounds
• Use alternative and augmentative communication e.g. sign language and visual aids to support language learning.
• Improve more complex speech disorders
• Increase vocabulary

Speech and language therapists can offer a range of effective interventions for children with Down syndrome. The type of intervention chosen will be specific to the individual's needs and abilities. The speech and language therapist will use the individuals strengths i.e. use of non-verbal communication to support their speech and language learning.