Archive for December 14th, 2018

Global Webinar Series – Winter 2018 Recap

December 14th, 2018 by Global Down Syndrome Foundation

WINTER 2018

Physical Therapy for Children with Down syndrome & How to Set your Child Up for Successful Learning Experiences


What You Need to Know


Overview & Speakers:

This webinar reviews physical therapy for children with Down syndrome and how to set up your child for successful learning experiences. Key takeaways from this presentation are:

  • Goal of physical therapy
  • Physical factors that impact the development of gross motor skills
  • Compensations for these factors
  • Crucial Components to develop when learning gross motor skills
  • Examples of how physical therapy addresses learning gross motor skills to help develop the crucial components
Pat Winders, PT

Pat Winders, PT

Patricia Winders, PT is the Director of Therapies and Senior Physical Therapist at the Anna & John J. Sie Center for Down Syndrome at Children’s Hospital Colorado. Prior to this position, she worked at the Kennedy Krieger Institute Down Syndrome Clinic in Baltimore, Maryland (from 1989-2007). Since 1981, she has specialized in providing physical therapy services to children with Down Syndrome. She is author of the book Gross Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals (Second Edition), published by Woodbine House (2014). She is a member of the Down Syndrome Medical Interest Group (DSMIG-USA) and also serves on the Professional Advisory Committee of the National Down Syndrome Congress (NDSC).


Overview:


Powerpoint Presentation: Click to Download


Stage 1-5 Handout: Click to Download


Questions & Answers:

Ashley, a parent in Pike Road, AL:

1. My son is 16 months old. He is sitting (does not get himself into sitting) and attempting to army crawl. He is still not bearing weight on his legs and does not plant his feet when held upright. What can I do to encourage him to plant his feet? Would orthotics help him?

I hope listening to the webinar (handout slides beginning with #26) helped you with this question. You and his PT need to figure out why your son is not bearing weight—is it due to weakness, or does he feel unstable (due to ligamentous laxity), or does he resist it (behaviorally) because he would rather be sitting (or doing another gross motor skill)? When you know why he is not bearing weight, then you can figure out the best strategies to help him tolerate practicing this new skill.

To help him tolerate taking weight on his legs, you can practice 90/90 sitting on a 5-6” high bench (Stage 3) and supported kneeling. You can also practice slide 27 (moving from 90/90 sitting to standing and lowering to sitting) either with a bench or with your child on your thigh.

It is hard to say if orthotics would help him at this early time without seeing his foot posture and degree of ligamentous laxity. It is best to discuss this with his PT.

 

Melinda, a medical professional in Highlands Ranch, CO:

1. What do you feel is the role of a school based physical therapist for a child with a diagnosis of Down syndrome in the preschool setting?

PTs in that setting have their guidelines for providing services. In general, I would recommend evaluating the children to determine if they safely negotiate independent mobility in that environment (walking up/down curbs and stairs, walking on uneven surfaces and inclines, and climbing/using playground equipment) and then to provide therapy based on the child’s needs. If there are ride on toys and tricycles, the child would also need to learn how to use them.

2. When do you recommend the use of SMAFOs and the discharge of SMAFOs?

I recommend using a certain type of SMAFO when the child needs this support for his/her degree of ligamentous laxity. If possible, I try to change to less support when the child is in kindergarten/first grade so that the child can be more independent with putting on/taking off shoes. I would be glad to discuss this with you. Please call me if you would like to discuss.

3. I typically see the private physical therapist discharge services after a child starts walking. Has this been found to be best practice?

There have not been any studies about this. After listening to the webinar, you know my recommendations to refine the walking pattern and to learn gross motor skills (running, walking up/down curbs and stairs, jumping, etc) in a way that develop the crucial components. For more information about gross motor skills in the Post Walking period of development, I would recommend my book Gross Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals (published by Woodbine House 2014).

 

Paige, a parent and 21 & Change org member in Ruskin, FL:

1. Is there any correlation between improved gross motor skills and improved speech and language skills?

I have not seen studies proving this.

2. How do we incorporate the gross motor skills practice into play activities to make it fun?

I always want to set children up to have fun when they are learning gross motor skills! It is important to pick the best motivators so your child wants to move to it and then has time to play with it while practicing the gross motor skill.

3. How do we know when our child has successfully achieved a gross motor milestone and it’s time to progress to the next one?

When a child initiates doing the skill and can do it on his/her own, then it is time to teach him/her the next level skill.

 

Kerry-Ann, a parent in Kingston, Jamaica:

1. At what age should I expect my daughter to be walking? She is now 1 year and 2 months. She always stands, but never takes a step.

There is a sequence of walking skills (webinar slides #31-37– cruising, walking with 2 hand support, walking with 1 hand support, lunging steps, first independent step) that a child needs to practice to gain the balance, strength, endurance and confidence to take independent steps. In my data collection of walking (with my definition of walking: to walk independently for 15’ distances), the median age is 24 months.

2. Is toe-tipping normal?

I have not heard of toe-tipping and do not know what you mean so, unfortunately, I cannot answer this question.

 

Shontie, a parent in Memphis, TN:

1. How can I get the school to implement these crucial components through more PT? I have a 3 year old daughter who receives PT 4x a year only and it’s due to her being able to walk. She cannot jump yet and many of the things you speak about may be helpful with posture and other gross motor skills. May I refer to your evidence based information in order to request more physical therapy in her school?

I would recommend discussing your child’s PT goals with her PT at school. Through this, you will understand how her current PT program is addressing the crucial components. If additional PT services are needed to address components or skills not being focused on, then she could be seen for private PT services on an out-patient basis.

 

Lyudmila, an org member in Erie, PA:

1. How can I help a child accept weight through the entire foot and how can I prevent them from shifting their weight to the heel?

If the child is shifting weight to his/her heels, it is because the child is standing with his/her pelvis behind his/her heels (side view) as in slide #26. If the child is standing (with support) as is seen in slides #27-28, then he/she will weight bear through his/her entire foot.

 

Marsha, an org member and other relative in West Melbourne, FL:

1. I have a 3 month old who is just starting PT. What questions can I ask to ensure her Physical therapist will set us on the right track? Are there certifications we should look for?

I would ask for a pediatric physical therapist and one who has had extensive experience with children with Down syndrome.

 

Yani, an org member and parent in Ruskin, FL:

1. Our 8 y/o daughter has a moderate pelvic tilt, low calf musculature, leans forward while running, slaps feet on surface when walking or running, and places a great deal of emphasis on her thighs for support. How might we start to correct this?

I would recommend practicing running (slide #40) with hand support to encourage a longer stride (step length) so your daughter learns to use hip hyperextension and toe push off (see slide #38). Also check your child’s shoes and foot support to see if this is contributing to her walking/running (foot slapping) pattern.

 

Angela, a parent in Boulder, CO:

1. Why is a laced shoe better? Is Velcro closure on athletic shoe not good? My son has hot dog insert is age 4 and running.

With your son’s foot support (HotDog inserts), the laces can be tightened to support his feet optimally over the foundation of the inserts. If he uses Velcro, the fit will not be as snug so his foot will move within the shoe and will be less stable.

 

Angela, a parent in Lorton, VA:

1. I have an 11 year old girl who has the s shape side profile. She started with Sure Steps in early years and then the doctor said she doesn’t need them. But she currently has them again because her feet were so pronated in and she couldn’t walk for too long. We are working on issues but is it too late to truly correct? Are we only compensating now?

You can still help her develop the strength to stand with an optimal posture and you can provide support (to her feet) to help her alignment for walking. If you would like guidance for exercises and foot support, she could be evaluated by a physical therapist in your area.

 

Elizabeth, a parent in Lakewood, OH:

1. What do you think about using supportive clothing- such as hip helpers or spio pants/vest to help children to develop correct muscle use in learning to sit/stand/walk?

I am familiar with these supports but I have not used them extensively in my treatment. My focus is on active movements when practicing skills and I provide handling to cue muscles to activate.

 

Patricia, a parent in Buranby, Canada:

1. I am an occupational therapist. I was just wondering what you would like OTs to know about GM development and how do you see us collaborating with PTs in help with gross motor development?

We each have different frameworks to observe the child (for each skill) and that is why the collaboration is so beneficial. I hope the webinar today gives you a framework for the goal of PT. To say how we would collaborate to help with gross motor development would depend on the specific gross motor skill to be practiced.

 

Jennifer, an org member in Sandusky, OH:

1. Is there anything that can be done to correct crucial components if they have been learned incorrectly? Is there a time limit to this?

You can improve the crucial components and it is important to identify what is missing or needs to be remediated and then to plan strategies (exercise, supports, etc) to develop them.

 

Samantha, a parent in Seattle, WA:

1. For the kids who are walking and older, are skiing and swimming good exercises for building up the core/abdominal strength?

Yes, children have improved core/abdominal strength from doing these activities. Also, running, climbing, and jumping are good for developing core strength.

2. My son is 6 and loves to run. His PT definitely works with him to jump.

If you need ideas for teaching your child to jump, you can refer to my book Gross Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals (published by Woodbine House 2014)—Chapter 13.

 

Hadley, a parent in Lodi, OH:

1. Our almost 3 year old son does well moving in and out of sitting but when he is working on something he does definitely contour to a rounded back. How do we get him to continue to sit up and have good posture when he’s concentrating? We have tried lots of things including prompts, a yoga wedge which does help some because it tilts his pelvis forward a little.

It is best to watch your child to see when he sits tall and then you can use that strategy/set up to increase the time that he sits tall. Sometimes, there will be times that he slouches but as long as this time is balanced with times that he is sitting tall, that is ok.

 

Tiffany, a parent in Brea, CA:

1. Does gross motor skills have any relation to fine motor skills?

They are related in that your child needs to be stable in a position so he/she can do fine motor skills with control. He/she also needs strength in his/her shoulders and trunk to manipulate toys well.

2. My 1 yr. old has been looking up and holding his arms out while moving all his fingers and I have to snap him out of it. Could this be seizures or spasms?

If you have this question, it is important to schedule an appointment with your child’s pediatrician to discuss what you are observing. You can videotape when your child does it and then show this to his/her doctor.

3. Is there an age guideline for what he/she should be doing by now? (Milestones that should be mastered by a certain age and how do we know if our children are where they should be?

See the references (slide #48) and my article that was just published by the Journal of Intellectual Disability Research.

 


 

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