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A mother of a 19-year-old daughter with Down syndrome, Maryanne Bruni, BScOT, OT Reg(Ont), an OT at Silver Creek Pre-School, Etobicoke, Ontario, says that early intervention, good medical care, and lifetime professional support is making it possible for people with Down syndrome to reach capabilities not considered possible a generation ago.

“OT, being oriented to the meaningful occupations of the child’s life, can contribute to setting the course for success in daily activities and a positive sense of self, which is essential to the ability to achieve,” says Bruni, who works with children ages 2 to 6 who have a variety of special needs, including Down syndrome.

The role of OT, according to Bruni, author of “Fine Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals,” is to ensure children with Down syndrome develop normal movement patterns that lay the foundation for fine motor skills. In assisting with the ongoing development of fine motor skills, OTs should pay attention to the development of stability of the shoulder girdle, sensory experiences, and good bilateral coordination, as well as the components of dexterous hand movements, says Bruni.

Positive Attitude

Children who have Down syndrome are sometimes labeled stubborn when in fact, experts say, it is more that they don’t know how to play or are frustrated and lose interest. An important component of successful OT input is to be able to engage a child so that he or she will be motivated to succeed. Then, the OT must make sure that the task or activity being learned is presented physically and cognitively in a way that enables a child to be challenged, but also to succeed, according to Bruni.

“Therapists need to realize that potential and have to push the child,” says Katie Frank, MHS, OTR/L, at the Jane and Richard Thomas Center for Down Syndrome, Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati.

“Use all of their sensory systems — visual cues, auditory cues, tactile cues — all the things you can to help [children with Down syndrome] learn in the most optimal way,” says Stacey Maignan, PT, MPT, at the Jane and Richard Thomas Center for Down Syndrome.

Frank recommends incorporating music and game playing into therapy. “I use tweezers and clothespins to really work on fine motor coordination and strengthening the fingers. The child doesn’t realize that when they’re playing KerPlunk or Hi Ho Cherry-O and they’re using tweezers or clothespins that they’re really working on fine motor skills,” she says.

Frank says her focus in therapy includes handwriting skills — in particular, learning a signature. “As [the children] grow, they’ll need to have a signature. So, if it’s only the first letter of their name, focus on the first letter of their name,” she says. Frank is among the therapists who uses the Handwriting Without Tears program. “It uses a multisensory approach to teaching the letters of the alphabet. You only have to know a few concepts in order to write the letters,” she notes.

Additional Considerations

Those with Down syndrome are at an increased risk for certain medical conditions, such as congenital heart defects, respiratory and hearing problems, Alzheimer disease, childhood leukemia, and thyroid conditions, according to the National Down Syndrome Society.

“You always have to be aware of what’s going with the child, medically. There are definitely frequent respiratory issues as well as congenital heart defects; so, you have to have a true global picture of the child,” Maignan says.

At the Thomas Center, Maignan says children with Down syndrome have a parent-directed team with professionals, including PT, OT, speech, the medical director, and special educators in nutrition and other disciplines. “That team is led first and foremost by the patient and parent; it would be a challenge if the parent isn’t involved,” she says.

The team approach to therapy can start as early as a few weeks after the child’s birth, when Maignan says the focus is to promote various positioning. She will later direct parents to help children sit up, supporting their heads. She stresses keeping posture as well-aligned as possible in all positions so as not to allow for wide hip abduction, and using light arms for balance.

“I really think that in our very special population, you can’t [do] physical therapy without the consultation of an occupational therapist, mostly because of sensory motor situations,” Maignan says.

Resources

Down Syndrome: Health Issues: www.ds-health.com

National Down Syndrome Society: www.ndss.org

Bruni, M. Fine Motor Skills in Children with Down Syndrome. 2nd ed. Bethesda, MD: Woodbine; 2006.

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Lisette Hilton is a medical writer for the Gannett Healthcare Group. To comment,
e-mail oteditor@gannethg.com.

© Copyright 2009 Gannett Healthcare Group