BY PATRICIA C. WINDERS, PT
SENIOR PHYSICAL THERAPIST, DOWN SYNDROME SPECIALIST
SIE CENTER FOR DOWN SYNDROME, 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.
Determine what motivates your child. Your child is more likely to move when there is something motivating him. For example, he may crawl to get to a favorite toy. When practicing motor skills, your child’s success and enjoyment will depend on how you play, what types of toys you use, and where you place them.
Think how your child thinks. Figure out what gross motor skills your child likes to do and then build on those skills. For example, if your child likes to be on his belly, teach him pivoting, crawling and climbing; if he likes to sit, teach him to move into sitting by himself. Children often are motivated to learn skills in a different order and it is OK to follow your child’s lead and work on what he is ready and willing to learn.
Set your child up to succeed. Practice skills that your child is ready to learn so that he can accomplish them. Practice when he’s at his physical best so that he has the energy, concentration and patience to work on new or emerging skills. Know how to position him and use the best motivators. Lastly, know when to quit. A few well-timed moments when your child understands a new skill and succeeds at it are much more valuable than an hour of struggling that leaves both of you frustrated and upset.
Read your child’s cues. Pay attention to how your child is responding to practicing the skills. If it is too hard, make it easier by changing the set-up or giving more support. Practice as long as your child is doing his best. The quality of time you spend practicing gross motor skills is much more important than the quantity.
Treat it as a game. You really want to think of teaching and practicing a skill as a game. First, introduce the “game” so your child feels and tolerates the movement. Second, help your child become familiar with the game and understand what you want him to do. Third, practice the game together and gradually lessen your support. Fourth, progress toward independence. The ultimate goal is for your child to master the game and be able to do it on his own.
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.