Downs_Syndrom

Pamela Doswell Gross Motor Skills in Down Syndrome Psychology 200 Professor Ralph Huling April 17, 2013 Children with Down syndrome have enormous potential, but it is only recently that we have learned to work with them to maximize that potential. Children with Down syndrome like other children, develop according to their own timetable. Some develop slower than others and some faster. In general, though a number of physical and medical problems can delay your child’s development of the various gross motor skills. Down syndrome children have low muscle tone, which is also called hypotonia. Hypotonia is most easily observed when they are infants. When you pick a baby with Down syndrome up you will notice that he or she feels floppy or somewhat like a ragdoll. If you put him or her on their back his head will turn to the side, his arms will fall away from his body and rest on the surface, and his legs will fall open. The floppiness is due to reduced muscle tone and the low muscle tone, along with decreased strength and endurance, makes it more difficult to learn gross motor skills. Hypotonia affects each child to a different degree. In some children, the effect is mild and in others, it is more profound. The low tone improves over time but persists throughout life. Some areas of the body may be more affected than others. For instance, a child may have lower tone in the arms than in the legs. On the other hand, a child may have lower tone on the left side than on the right side. Hypotonia in a particular area will affect development of skills that require the use of that area. For example, a child with lower tone in his arms will find it more difficult to learn to belly crawl and to pull to stand since he needs to use his arms to perform these activities. A child with lower tone is his stomach will find it more difficult to balance in standings and to learn to creep on his hands and knees, since he needs to use his stomach muscles for these skills. At first, you may not be able to tell the degree of low muscle tone that your child has or whether some areas are more affected than others are. As you work with your child, you will begin to recognize patterns that give him particular difficulty. For instance, you may notice that he has trouble with and tends to avoid activities that require the use of his arms. He may not like to prop on his stomach or pull himself up. These may be clues that this is an area of weakness for him. As time goes on you will be able to identify what areas are weaknesses for him and therefore need extra work. Children with Down syndrome have short arms and legs relative to the length of their trunks. The shortness of their arms makes it more difficult to learn sitting because they cannot prop on their arms unless they lean forward. When they fall to the side, they have to fall farther before they are able to catch themselves with their arms. The shortness of their legs makes it harder to learn to climb, since the height of the sofa or stairs presents more of an obstacle. Down syndrome also causes decreased muscle strength in children, but strength can be greatly improved through repetition and practice. Increasing muscle strength is important, because otherwise children with Downs tend to compensate for their weakness by using movements that are easier in the near term, but are detrimental in the long term. For example, your child may want to stand, but because of weakness of the trunk and legs, he can only do it if he stiffens his knees. You will be able to help him develop the strength he needs so that he can stand properly without stiffening his knees. Like all children, children with Downs want to move, explore their environment, and interact with people and toys, but their physical problems create obstacles. An infant lying on the bed looks at toys and wants to touch them, but cannot hold his head in the center and reach upward because of low muscle tone and inadequate strength. If support is provided under the child’s head and arms and the toy is properly placed, he will be able to touch it. Once a child has learned to sit, he will want to pull up to stand. He will be unable to, however, because he is not strong enough to maintain himself on hands and knees, the position from which children usually learn to pull up to stand. If he is provided with an edge to hold onto such as the edge of a laundry basket he will be able to learn to pull up to stand from sitting on a bench. Providing strategically targeted support gives your child the opportunity to do what he already wants to do, but cannot, due to his physical problems. Once he is successful, he will be motivated to do it again. Through repetition of those movements, he will begin to develop strength so that he requires less support. Eventually, he will be able to do the skill with no support at all. Many children have medical problems that affect their ability to engage in gross motor skills. Theses include heart problems, stomach or intestinal problems, chronic upper respiratory infections, and ear infections. These may cause a child to fatigue easily and to have poor endurance. Ear problems can also affect balance, particularly when a child is working on standing balance and walking. You will need to make certain that you are not overexerting your child. Once his medical problems have improved, he will be able to do more and can make up for lost time. Your child will need a motivator to get his attention and to encourage him to move. For example, he might crawl to get to a favorite toy. Motivators can also be special playtime with you or family members. When practicing motor skills, your child’s success and enjoyment will be dependent on how you play, what type of toys you use, and where you place them. To motivate your child effectively, you need to know what he is interested in and how to use it skillfully to achieve the motor skills he is practicing. The quality of time you spend working on motor skills tends to be much more important than the quantity. Proper timing is crucial in teaching your child new skills. You do not want to introduce a new skill until he is ready to accomplish it. If he is not ready, both of you will become frustrated. If he is ready and you can help him practice it, he will learn it and both of you will succeed. When he is learning a skill, you need to be consistent with how you set it up and practice. When practicing motor skills, use your time strategically. Work on skills that require your support rather than skills that he can do by himself. Alternate hard and easy activities and combine them with play. When he becomes tired, do easier activities, or let him play by himself. After he plays by himself for a few minutes, he may be ready to practice again. If not, give him a break until his next active period. When he is learning a new skill, first motivate him to do it, work on refining it only after he has been successful. While researching about motor skills in children with Down syndrome I have found that they fall into two basic categories of temperament, Motor Driven and Observer. You will be able to distinguish which temperament your child has by watching whether he stays in one position or moves a lot, whether he is cautious or takes risk, whether he moves slowly or quickly. You can begin to observe these characteristics when your child is 6-12 months old, and you will continue to notice them in more subtle ways throughout his childhood. References “The Out-of-Sync Child” Carol Stock (Carol Stock Kranowitz, 2005) “Early Communication Skills for Children with Down Syndrome” (Libby Cumin, 2003) “Gross Motor Skills in Children with Down Syndrome” (Patricia C. Winders, 1997)