PRESENTATION ON

DOWN SYNDROME

M. ARUN KUMAR , B.O.T Occupational therapist

Down syndrome is a genetic disorder that causes lifelong mental retardation, developmental delays and other problems. , Down syndrome occurs when there is an extra copy of chromosome 21. This form of Down syndrome is called Trisomy 21. The extra chromosome causes problems with the way the body and brain development

Common physical signs Decreased muscle tone at birthExcess skin at the nape of the neckFlattened nose Separated joints between the bones of the skull

(sutures) Single crease in the palm of the hand Small ears Small mouth Upward slanting eyes Wide, short hands with short fingers White spots on the colored part of the eye

(Brushfield spots)

Birth defects involving the heart, such as an atrial septal defect or ventricular septal defect

Dementia may be seen Eye problems, such as cataracts (most

children with Down syndrome need glasses) Early and massive vomiting, which may be a

sign of a gastrointestinal blockage, such as esophageal atresia and duodenal atresia

Hearing problems, probably caused by regular ear infections

Hip problems and risk of dislocation Long-term (chronic) constipation problems

Sleep apnea (because the mouth, throat, and airway are narrowed in children with Down syndrome)

Teeth that appear later than normal and in a location that may cause problems with chewing

Underactive thyroid (hypothyroidism

ROLE OF OCCUPATIONAL THERAPY FOR CHILDREN WITH DOWN SYNDROME

self care skills (feeding, dressing, grooming etc.)

fine and gross motor skills skills related to school performance (eg:

printing, cutting etc.) Psycho-social adjustment through

games and interactive projects, games, plays, and other activities.

FINE AND GROSS MOTOR SKILLS

REACH : Movement and stabilization of the arm and hand

trunk rotation, full elbow extension, slight forearm rotation, and wrist stability, some degree of excess finger extension.

GRASP: Attainment of an object with the hand along with reach thumb may be held

flexed or abducted to other fingers

CARRY:Transporting a hand held object from one place

to anotherFrequently the forearm position and the

wrist positionmust be able to be modified during the carry so the object remains in an optimal position. Also shoulder rotation patterns simultaneous with shoulder flexion and abduction.

RELEASE: The intentional letting go of a hand –held object

To place an object for release, the arm needs to move into position accurately and then stabilize as the fingers and thumb extend.

IN-HAND MANIPULATION: The adjustment of an object within the hand after grasp

BILATERAL HAND USE: Use of two hands to gather to accomplish an activity

Ex- ball throwing skills child must bring the arm into a starting

position,Then prepare for projection of the ball into

space by moving first the trunk with the scapulohumeral joint

then stabilize the shoulder while beginning to extend the elbow

Then stabilize the elbow while moving the wrist from extension to a neutral position and simultaneously forcefully extending the fingers and thumb

1. TRUNK AND NECK CONTROL PRONE EXTENSION SUPINE FLEXION TRUNK ROTATION

2. SHOULDER AND ARM STABILITY

3.BIMANUAL COORDINATION

4.FUNCTIONAL GRASP FOREARM SUPINATION WRIST STABILITY ARCH DEVELOPMENT RADIAL-ULNAR DISSOCIATION OPEN WEB SPACE THUMB OPPOSTION IN-HAND MANIPULATION

TRUNK AND NECK CONTROL: Strong trunk and neck muscles allow the child

to sustain an upright posture and hold up the head and shoulders against gravity.

PRONE EXTENSION:The child supports the body on the

abdomen(stomach) in a prone position.ACTIVITIES: prone position on a scooter board

swing, spinning board

coloring, looking at books, playing board games

Adaptive positions used

SUPINE FLEXION: Supine flexion involves lying on the back in a

supine position.

ACTIVITIES: Children can reach high with their hands for

objects like balls,balloons,bean bags .

Can kick, touch, lift objects with their feet Abdominal exercises

TRUNK ROTATION: Trunk rotation requires use of trunk extensor and flexor

muscles.ACTIVITIES: Sitting /standing on ball and put rings

Sitting on balance board do rotation

SHOULDER AND ARM STABILITY: Shoulder stability adds to the trunks base of

support, which is needed for hand mobility.ACTIVITIES: Attach push pins to a cork board on a wall. Loop

colorful rubberbands around the push pins to make patterns

Coloring

BIMANUAL COORDINATION:

Both hands must be used smoothly together for handwriting

ACTIVITIES:

clay activities, ball thronging

FUNCTIONAL GRASP:

FOREARM SUPINATION;

An efficient pencil grasp the forearm is neither palm down nor palm up. partial suspiration (partial palm –up )

ACTIVITIES: Nut and bolts, clapping hands on the legs palm up and

palm down in rhythmic patterns

Using a toy screwdriver

WRIST STABILITY:An efficient pencil grasp requires stability and

30 degrees of wrist extensionACTIVITIES: Beads ,clay activities

ARCH DEVELOPMENT:

Transverse longitudinal oblique

(side to side) (fingertip to wrist)

(diagonal)

ACTIVITIES: Manipulating pegs of varying sizes

cupping round objects in the palm

shake dice,rice,marbles

Pulling tiny objects with the thumb and little finger

RADIAL-ULNAR DISSOCIATION: Stability on the ulna side (little finger) of the hand

supports the skilled movements on the radial side(thumb) of the hand.

ACTIVITIES: Using tools ,such as

hairbrushes,toothbrushes,play hammers, drum sticks or play screwdrivers

Using toy scissors

Operating any squeeze or pump spray bottle or squirt gun

Pulling ropes, tubing and thick objects

OPEN WEB SPACE

An open web space(the loose skin between index finger and thumb)in a pencil grasp allows nerves to send accurate sensory-motor information between the tips of thumb, index finger and middle finger, and the brain.

ACTIVITIES: Weight bearing on an open hand

Gripping or holding wide, hand-sized objects such as a cup, large block

THUMB OPPOSITION• In an efficient pencil grasp the thumb rotates

toward the little finger resulting in the tip of the thumb moving opposite the tip index finger

ACTIVITIES: Using a toy requiring the thumb to push a

button opposite the index and middle fingers.

Pulling tiny objects out of putty or clay

IN-HAND MANIPULATIONTRANSLATION -FINGERS TO PALM ACTIVITIES: Getting a coin out of a change purse

Crumpling paper

Picking up and bringing small piece of food into the palm

TRANSLATION-FINGERS TO PALM WITH STABILIZATION

Getting two-or more coins out of a change purse, one at a time

Picking up pegs or paperclips one at a time to hold two or more in the hand at one time

TRANSLATION-PALM TO FINGERS: Moving an object to put it into a container

Moving a food item to put it in the mouth

TRANSLATION-PALM TO FINGERS WITH STABILIZATION

Putting one utensil down where holding several

SHIFT Turning pagers in a book

Picking up sheets of paper, tissue papers

Separating playing cards

String beads

SIMPLE OR COMPLEX ROTATION Removing or putting on a small jar lid

Putting on or removing bolts from nuts

Rotation of a crayon or pencil

GROSS MOTOR SKILLS

Movement of the large muscles in the arms, and legs.

Abilities like RollingCrawlingWalking Running JumpingHopping Skipping

Tumble crawl vestibular dome

Therapy ball activities

Walking Balance beam balance board

climbing wall

Foam steps

Balance bar Rotation board

Barrel activities tunnel

WHY ARE GROSS MOTOR SKILLS IMPORTANT FOR STUDENTS?Gross Motor skills and mastery of

the large muscle groups provide the foundation for movement, coordination and balance.

Safety, in the classroom, on the playground, and in the gym.

Gross Motor Skills build the foundation for fine motor skills: If a child has difficulty sitting in a chair, writing and coloring will be more of a challenge.

ACTIVITIES OF DAILY LIVING:

Self – care skills like daily Brushing Toilet tasks Bathing Grooming Dressing Feeding

Brushing Step by step method

Initially with physical and verbal prompt

slowly reduce prompt.1.Get your toothbrush

2. Put toothpaste on

3. Brush upper surface of lower teeth

4. Brush outer surface of lower teeth

5. Brush inner surface of lower teeth

6. Brush outer surface of upper teeth

7. Brush inner surface of upper teeth 8. Spit9. Rinse10. Clean-up

Bathing 1.Take water2. Pouring water over chest 3. Pouring water over left shoulder right

shoulder 4. Applying soap over chest left hand left leg

right hand right leg back5. Rubbing all the body part6. Pouring water7. Weeping

Dressing frames

Dressing On/Off1. On lap method identifying front and

back of the shirt or T-Shirt.

For T-shirt

On/Off lower Garments

Eating Grooming

Putting shoes

VOCATIONAL REHABILITATION

PAPER BASED WORK Book binding

Paper bags preparation

greeting cards making

CRAFT AND TAILORING glass painting

• embroidery• soft toy making• block painting• fabric painting DOMESTIC ACTIVITY Tea and snacks preparation Chocolate preparation Chain making• gardening

AIDS TO DAILY LIVINGS

Cross over grip bip gip built-up

handle

Long handled brushes and combs zip

grips