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.
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.
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
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
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
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
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
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
• 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
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