Physical Therapy for Infant and Child
by Pat Winders, P.T.
A pediatric physical therapist specializes in how children move in their environment and what movements are necessary to develop gross motor skills. Examples of gross motor skills include: propping on arms in stomach-lying, rolling, hand to foot play when back-lying, sitting, moving in and out of sitting, crawling, pulling to stand, standing balance, walking, climbing, running, jumping, tricycle riding and stair climbing.
Infants and children with Down syndrome have 3 primary physical problems that affect their gross motor development. The characteristics are "floppy" muscle tone (hypotonia), decreased strength and hypermobility of their joints. These physical issues need to be monitored and a physical therapy evaluation is needed to determine the impact of these factors on the child's development of gross motor skills.
Children with Down syndrome will develop the major milestones including walking, running, and stair climbing. However, to do this, they will need to develop strength and control in the muscles of the neck, arms, stomach and legs. They will need to learn how to balance their bodies in each position and while playing. Physical therapy intervention is needed to teach each child how to develop gross motor skills without using abnormal movement patterns which frequently occur due to the hypotonia and hypermobility.
It is recommended that physical therapy services be started as early as possible (1-2 months of age). During each session, the child is evaluated and a treatment program is developed. Parent training is provided and it is recommended that the program be implemented on a daily basis. With frequent practice, the child learns the new skills and then returns for the next physical therapy session. The recommended frequency of services using this parent training model is 1-2 times per month until the child is able to walk. When the child is an independent walker, the frequency decreases to 3-4 times per year. Physical therapy follow up is terminated when the child is able to run, walk up and down stairs, negotiate curbs and ramps, walk on a balance beam, jump and ride a tricycle. At this time, it is beneficial for the child to participate in community-based group programs (e.g., dance, swimming, running, gym and playground activities and sports) to combine socialization and play with gross motor activities.
In summary, early physical therapy intervention assists children with Down syndrome in developing optimal movement patterns which build the foundation for motor performance to become an area of strength. Appropriate ongoing therapy can challenge the children and, at the same time, increase their motivation, confidence, and trust in their own abilities.
| Milestones | Range (months) | Average |
| Rolling | ||
| back to stomach | 5-9 | 7 |
| stomach to back | 4-8 | 6 |
| Sitting without support (5 minutes) | 7-15 | 11 |
| Belly crawling (minimum distance 5 ft) | 9-19 | 14 |
| Creeping (on hands and knees; (minimum distance 10 ft) | 10-24 | 17 |
| Pull to stand from hands and knees | 11-23 | 17 |
| Stand alone (10 seconds) | 16-26 | 21 |
| Walking alone (minimum) distance 15-20 ft) | 17-35 | 26 |
Harris, S.R., & Shea, A.M. (1991). Down syndrome. In S.K. Campbell (Ed.), Clinics in physical therapy: pediatric neurological physical therapy (2nd ed., pp. 131-168). New York: Churchill Livingstone, Inc.
Shea, A.M. (1991). Motor attainments in Down syndrome: Contemporary management of motor problems. In Proceedings of the II Step Conference (pp. 225-236). Alexandria, VA: Foundation for Physical Therapy.
Winders, P.C. (1997), Gross Motor Skills in Children with Down Syndrome: A Guide for Parents and Professionals, Bethesda, MD; Woodbine House.
The article above is reproduced from the Down Syndrome Guide disseminated by the Down Syndrome Clinic at Kennedy Krieger Institute. In accordance with federal copyright restrictions, the contents of this booklet may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 George Capone, M.D.
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