| Physical & Occupational Therapy - Gross Motor Development and Down Syndrome |
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Gross Motor Development and Down Syndrome
Written by Patricia C. Winders, PT
Senior Physical Therapist, Down Syndrome Specialist
Sie Center for Down Syndrome
The Children's Hospital, Aurora, CO
What are some of the challenges that babies with Down syndrome face in their gross motor development?
Children with Down syndrome want to do what all children want to do: they want to sit, crawl, walk, explore their environment, and interact with the people around them. To do that, they need to develop their gross motor skills. Because of certain physical characteristics, which include hypotonia (low muscle tone), ligamentous laxity (looseness of the ligaments that causes increased flexibility in the joints), and decreased strength, children with Down syndrome don’t develop motor skills in the same way that the typically-developing child does. They find ways to compensate for the differences in their physical make-up, and some of the compensations can lead to long-term complications, such as pain in the feet or the development of an inefficient walking pattern.
The goal of physical therapy for these children is not to accelerate the rate of their development, as is often presumed, but to facilitate the development of optimal movement patterns. This means that over the long term, you want to help the child develop good posture, proper foot alignment, an efficient walking pattern, and a good physical foundation for exercise throughout life.
What do you do in a typical physical therapy session?
First, I observe what skills the child has already mastered on his or her own. Then I determine what the child is ready to learn next. It’s critical that we teach children what they’re ready to learn within the next month rather than work on something that’s too advanced for them.
Once I know what skill the child is ready to learn, I develop a way to teach him that skill. I break the skill down into its component parts, and then I practice the skill with a variety of strategies to test with which method the child is most successful. The strategies are based on the child’s learning style and physical make-up.
Lastly and most importantly, I teach the parents how to practice the skill with their child. The parents can practice the skill when the child is feeling rested and strong, and the skills can be incorporated into the daily routine. Through practice and repetition, the child will develop strength and efficiency, leading to mastery of the skill.
You write that children are typically either “motor-driven” or “observers” by nature. How does temperament impact physical therapy?
Temperament is a person’s characteristic manner of thinking, behaving and reacting. I look at a child’s pattern of thinking, behaving and reacting when learning gross motor skills. It is my observation that children with Down syndrome fall into two basic categories of temperament: motor-driven and observer. Children who are motor-driven tend to be risk-takers. They like to move fast and tolerate new movements and positions. They do not want to stay in one place and dislike being stationary. Children who are observers are more cautious, careful, and want to be in control. They prefer stationary positions and are easily frightened when learning new movements.
When children who are motor-driven are learning how to walk, for example, they will take risks to take independent steps and will be undeterred by frequent falls. Observers will be more cautious and will only risk independent steps when they are sure of their balance.
Understanding your child’s temperament and what motivates him will help you be more effective in helping him learn gross motor skills. You will know in advance which activities he is likely to enjoy and which activities he is likely to resist. Knowing this, you can begin with activities he enjoys and only move on to more difficult ones when he is well rested and motivated to learn.
What are some general tips that parents should keep in mind when working with their child on gross motor skills?
The development of gross motor skills is the first learning task that the child with Down syndrome and his parents will face together. This is an opportunity for parents to begin to understand how their child learns. Use these tips as a starting point to begin to explore your child’s learning style.
Children with Down syndrome have a unique learning style, and we need to understand and respect it. A psychologist named Jennifer Wishart has written extensively on this subject. She says we “could run the risk of changing slow but willing learners into reluctant, avoidant learners.” I really customize the work I do with each child. I make sure the physical therapy sessions provide a pleasant learning environment for children so that they are willing learners, and I encourage parents to do the same at home. If your child feels imposed upon, he or she is just going to find ways to resist and avoid learning.
Resources:
Gross Motor Skills in Children with Down Syndrome: A Guide for Parents and Professionals (1997) by Patricia C. Winders. Published by Woodbine House.
“The Goal and Opportunity of Physical Therapy for Children with Down Syndrome.” (2001) Down Syndrome Quarterly 6(2), 1-4.
Down Syndrome: The First 18 Months (2003) by Will Schermerhorn.
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