Down Syndrome

Question 1

What are characteristics of DS (crainiofacial, MS, CV, eyes/ ears, GI, neurologic, immunologic)?

Answer 1

1. Craniofacial = Anomalous ears, low nasal bridge, inner eipcanthal folds, upward slanting eyes, shortened palate
2. MS = Diastisis recti, joint hypermobility, ligamentous laxity, shallow acetabular angle, atlantoaxial instability, Simian crease, wide gap between toes 2 and 3
3. eyes/ ears = Myopia, nystagmus, strabismus, tear duct blockage, conductive hearing loss
4. CV = VSD, PDA, Tetralogy of Fallot (40% born with hear defect); Many kids with DS have congenital heart defect
5. Microcephaly, hypotonia, ID, developmental delay, early onset Alzheimer’s disease, small cerebellum and brainstem
6. Leukemia, chronic rhinitis, fluid in middle ear

Question 2

What are physical obsticals to gross motor development in children withDS?

Answer 2

1. hypotonia
2. joint laxity
3. Decr. Strength
4. Short arms and legs

Question 3

Caused by laxity of the transverse ligament, which holds the odontoid process of the axis in place on the inner aspect of the anterior arch of the atlas. This ligament assists in maintaining integrity of the C1-C2 articulation.

Answer 3

AA instability

• Xray in lateral view: neutral, full flexion, full ext
• 10-20% of indiv with DS
• look for UMN lesion signs
• may only participate in noncontact sports

Question 4

While children with DS achieve gross motor milestones?

Answer 4

yes, the rate of acquisition will typically be slower

• usually walk by 2 years
• rate determined by degree of hypotonia, lig laxity, strength, and any confounding medical issues

Question 5

What is the role of PT in DS?

Answer 5

1. Promote optimal functional development
2. Minimize the development of abnormal compensatory movement patterns that children with Down syndrome are prone to develop - makes child prone to developing ortho and fxn’l problems

Question 6

What are orthopedic issues with DS?

Answer 6

1. Congenital Flat feet
2. Patellar instability
3. Hallux valgus
4. Flat Feet
5. Scoliosis
6. Arthritis

Question 7

What are gait deviations from flat feet?

Answer 7

1. Increased gait variability
2. Out-toeing
3. Flat foot at initial contact
4. Wider base of support
5. Poor foot control

Question 8

What is the effect of treadmill training in infants with DS?

Answer 8

Infants who received treadmill training early walk earlier than other children with DS

Question 9

When should you introduce an orthotic to a child with DS?

Answer 9

when child uses walking as primary means of mobility

• orthotic prevents long term complications
• introducing too young can impair develop\pent

Question 10

What are fitness issues with children with DS?

Answer 10

1. Cardiovascular capacity is lower
2. Max HR is ~10% lower (one study showed higher)
3. Lower peak oxygen consumption
4. Lower peak ventilation
5. Lower respiratory exchange ratio

Question 11

What are the ACSM guidelines for exercise for people with DS?

Answer 11

1. 20-60 minutes of aerobic activity
2. 3-7 times each week
3. Intensity of 55-85% peak heart rate or 40-85% VO2 Max
4. Peak Heart Rate= 220-age

Question 12

What are exercise prescription considerations for people with DS?

Answer 12

1. obtaining physician consent
2. understanding the effects of medications on the body in relation to exercise
3. providing augmented supervision
4. incorporating behavioral therapy and motivational techniques (i.e., token reward system) to improve adherence
5. starting the program with light activity that is enjoyable and pain-free.
6. Strength training
7. No flexibility

Question 13

What are considerations for school aged/ adolescent people with DS?

Answer 13

1. Tend to be less active
2. Obesity is a common problem (25%)
3. Socially appropriate gross motor activity should be encouraged
4. Therapist-consultant for participation more fully in social/recreational activities and PE
5. Consultant