OccupationalTherapy for Down syndrome in Children
OccupationalTherapy for Down syndrome in Children
Downsyndrome is a clinical condition occurring in individuals havingpartial or extra copies of chromosome 21. The genetic materialsinterfere with development causing Down syndrome characteristics.Down syndrome traits include small stature, low muscle tone, eyesthat slant upwards and a deep crease across the center part of thepalm. Down syndrome is common in the United States affecting morethan 400,000 Americans and over 6,000 babies (National Down SyndromeSociety, 2012a). Down syndrome is of three types, namelytranslocation, trisomy 21(nondisjunction), and Mosaicism.
SarahDown Syndrome case
Sarahis aged three years presented to the hospital having problems of finemotor skills. The option is to plan on how to conduct a baselineassessment grasping and visual motor integration subsets of thePeabody development motor scales (PDMS-2).
Gatheredbackground information indicates that Sarah`s mother is aged 30years, which is a factor, contributing to her present condition. Themother shows that two members of the extended family have Downsyndrome. Thus, there were higher chances of the mother being a Downsyndrome carrier. The family lives in a residential area and earns ahigh income. She has delayed language and retarded mental ability.Her motor development is slow, and her muscles are hypotonic. Thegirl has had impaired communication and coordination (Down SyndromeEducation International, 2016a). Her ground activities are limited toclimbing stairs and playing with a ball.
Plans for the assessment included sending a letter and contacting theparents from details left in the office. The parents agreed toparticipate in the evaluation two weeks after visiting the hospital.Forms including questions on motor skills are prepared for theassessment.
Finalpreparations and checkpoints
Finalpreparations included preparing a questionnaire to fill in whenperforming the interview. The meeting avoids actions painful andannoying to the child.
The presentation involved explaining the benefit of taking the testwas to examine locomotor skills and object control skills of theirchild.
The interview with the parent enquired on how long the problem wasexperienced and whether they had tried other means to heal it. Morequestions asked the current physical activities the child wasinvolved in and therapies attended. The parents explained that shehad delayed language and mental ability. Her motor development isslow, and her muscles are hypnotized (Down Syndrome EducationInternational, 2016a). The girl has had impaired communication andcoordination. Her ground activities are limited to climbing stairsand playing with a ball.
Toobserve the child informally, she was set free to run, hop, jump, andleap. The skills helped identify locomotor skills. Object controlskills were learned after giving a ball to the child and observingher response and ability to catch, kick, dribble stationery, throw itoverhand and roll it underhand (Down syndrome educationinternational, 2016).
Modelsand approaches guiding the assessment and intervention
Peabody development motor scale (PDMS-2) conducted the evaluationprocess. Intervention approaches involved environmentalmodifications, recommendations, education, parents and strategiesaimed at improving muscle and joint flexibility, balance, power,strength and proprioception to enhance coordination of the limbs(Episito, 2015).
Occupationanalysis: Assess performance and child factors
Sarahscored 4 in performance satisfaction scored 3 for the ability toclimb stairs.
Occupationanalysis: contexts and activity demands, environment
Thebusiness needs and participation in environmental activity scoredone. The coordination ability is poor thus making her unable toparticipate in playing outside.
The occupational therapy program was a collaboration with parents,nurses, child (Sarah), and other team members. They assisted identifynecessary plans required for evaluation.
Assessmentsforms to be completed
Administerage-appropriate assessment of the Peabody Developmental Motor Scales(PDMS-2) (Only these sections: Object manipulation, Grasping,Visual-Motor Integration)
According to Sacks and Buckley (2003), Visual-motor integration amongchildren is delayed. Children with Down syndrome roll at average agesof five months. They can sit steadily without support at the averageage of seven months range of (8-16) months. They quickly pull tostand at the middle ages of eight months ranging (10-24) months. Theystand alone at the average age of eight months (10-24) months. Theywalk without support three steps and more at a median age of 13months (16-42) months. They can grasp cubes at five months of age(4-10) months. They have the ability to pass objects from hand tohand at the average age of five months (6-12) months.
Theycan put three and more objects at twelve months ranging from 12 to 34months. They build a tower of two-inch cubes at fourteen months (14to 32) months.
Averagechildren walk at thirteen months ranging from 9-17 months, while Downsyndrome children walk after attaining 24 months ranging from 13 to48 months. They take long to improve on skills and littlecoordination. They have a delicate balance, especially when riding abicycle. They are slow to react and move. Down syndrome children havebetter visual and learning skills demonstrated through copying andmodeling than through verbal instructions. Children born with Downsyndrome have weak muscles responsible for poor motor functioning.
ShortSensory Profile (SSP) among Down syndrome children
Sutton& Rawlinson (2016) outlines a sensory profile for children withDown syndrome
They negatively respond to unexpected loud noises, often hold theirhands over their years, and cannot work with background noises. Theyslowly respond to the call of their names, or not at all, and areoblivious in an active environment.
Theyprefer staying in the dark, have difficulties of gathering puzzles,and hesitate going up and down steps. They quickly get lost and arebothered by bright lights. They intensely stare at people, objects,and avoiding eye contacts. They fail to recognize when visitors entertheir rooms.
Theyavoid certain tastes and smells, which are major parts of childrendiets. They often smell nonfood objects, put their fingers in themouth, and chew nonfoods. They chose what to eat depending on thetastes. They single out various tastes.
Theyhave weak muscles, get tired after short times, and assume stiffmovements and difficulty in lifting objects. They hang on objects andother familiar people.
Theyfear falls, avoid jumping and climbing objects they dislike whentheir heads are upside down and are stressed when their feet are offthe ground. They avoid toys and seek all types of movement. Theyavoid risks in playgrounds and twin themselves many times during theday.
They avoid messing with glue, sand, paint, tape, and delicatefabrics. They avoid walking barefoot and have great need textures andtoys. They rarely realize pain and temperature.
Attention,behavior, and social
Theyjump from one activity to another interfering with play, aredifficult to pay care and have great trouble when growing up. Theyare anxious, prone to accidents, and face difficulties of makingfriends. They are overly affectionate to others and are too serious.They do not have senses of humor and are hard to express emotions
Interpretsynthesize and summarize your evaluation data
Sarahis right in manipulating and grasping objects. She is poor invisual-motor integration. Sarah has heard a slower progress comparedwith normal children. She is better when using non-verbal skills suchas gestures and babbling. She learns better with pictures andobjects. Sarah has delayed social functioning, unclear speech, andmotor skills. She is slow in speech and mastering sentencestructures. She has interrupted short-term memory and struggled withnumber skills. Sarah is right on non-verbal skills such as graspingpellets, shaking the rattle, understanding cube, while seating on thelap and facing the table. However, she has a problem of working whenlying on the back. The states explain that Sarah has a problem withthe reflex system, which is associated with Down syndrome children.
Documentand share your evaluation results
Evaluation results indicate that Sarah scores an average of 2 innon-verbal skills and one or below in activities of short-term memorysuch as tracking a ball, and a rattle. She scores a zero whenrequired to perceive a rattle due to weaknesses of her short-termmemory. She scores a 2 when asked to perform non-verbal activitiessuch as extending the arm and bringing hands together.
Needfor OT services and the rationale
Occupational therapy services enable the child to master skillsrequired for independence. Occupational therapists equip the childwith self-care skills, fine and gross motor skills, and play andleisure skills. Occupational therapists assist with motor skills tocorrect feeding problems. They help position the child andintroducing alternative feeding techniques. The parents are educationon different types of nutrition. Second, they facilitate motormilestones for fine motor skills. The occupation therapists helpSarah to sit, crawl, stand, and walk. They concentrate on promotingarm and hand movements with the aim of developing fine motor skills.Occupation therapies happened in the hospital at scheduled times withthe doctor (Bowlds, Crump, and Schnell, 2016).
Developrecommendations and intervention planning including 3 STG & 3 LTG
Occupational therapy for STGs includes manipulating objects,arranging and rearranging play items, and utilization of sensorystrategies. Occupational therapy for LTGs includes improving sensibleregulation, improving FM skills, organizing, and rearranging objects.
Providethree occupation-based intervention strategies
The patients are asked to pre-write strokes, perform in a functionalplay, stretch hands to remove, and wear socks. The plan is repetitiveto use toys and increasing their weight gradually. Sustaining stretchin a slow manner to strengthen muscles is a form of intervention(Bowlds, Crump, and Schnell, 2016).
Speech therapy for LTGs includes the use of descriptive vocabulary.The patients participate in arranging and reaching for objects,assisted on how to be attentive to tasks and FM skills (Bowlds,Crump, and Schnell, 2016).
Providerecommendations for a specialist for consultation and intervention(either internally or externally to the OT profession) – explain therationale.
Aspeech-language pathologist can develop a comprehensive treatmentplan to work with families. A home and a community program developstronger communication skills. OT professionals can offeraccommodations like preferential seating to assist end problems ofhearing and listening (National Down Syndrome Society, 2012).
Bowlds,A., Crump, A., Schnell, K. (2016).Effective collaboration between PT, OT, and speech. Conventionhandouts,1-14.
Downsyndrome education international. (2016). Developmentand learning. Down syndrome education international.Retrieved from
Episito,P. (2015). Concurrent validity of TGMD-2 and TGMD-3 in children withDown syndrome. Thesis,Texas Christian University,1-36.
NationalDown syndrome Society. (2012). what is Down syndrome? NDSS.Retrieved from http://www.ndss.org/down-syndrome/what-is-down-syndrome/
NationalDown syndrome Society. (2012a). Speech and language therapy forchildren and adolescents with Down syndrome. NDSS.Retrieved from http://www.ndss.org/resources/therapies-development/speech-language-therapy/speech- language-therapy-for-children–adolescents-with-down-syndrome/
Sacks,B., &Buckley, S. (2003).What we know about the movement abilitiesof children with Down syndrome. Downsyndrome news and update,2(4), 131-141.
Sutton,Shirley. & Rawlinson, R. (2016).Sensoryprofile for children between three and ten. CASANA.Retrieved fromhttp://www.apraxia-kids.org/library/sensory-profile-for- children-between-three-and-ten/