Before discussing what the goal of physical therapy for children with Down Syndrome (DS) is, it is necessary first to understand what the goal is not. The goal of physical therapy is not to accelerate the rate of gross motor development. This statement is more controversial than it may initially seem to be. Many parents, many physical therapists and many insurance companies assume that the value of physical therapy can be measured by whether or not a child is achieving motor skills more quickly.
Some therapeutic techniques promote themselves by saying that children who are treated with that technique develop motor skills earlier. If, however, one begins with the premise that the goal of physical therapy is to accelerate the rate of gross motor development, then one needs to answer the question posed by that mother.
What difference will it make in 9 or 10 years that a child with DS walked at 21 months rather than 24 months of age? How will that three-month difference affect a child’s long-term functional outcome? I do not believe that it will make any difference whatsoever, and therefore, I do not believe that it is the appropriate goal for physical therapy for children with DS.
The rate of gross motor development in children with DS is influenced by a number of factors, including hypotonia, ligamentous laxity, decreased strength and short arms and legs. These factors are determined by genetics, and although some may be influenced by physical therapy, they cannot be fundamentally altered.
So them what is the goal of physical therapy for children with DS? Children with DS attempt to compensate for their hypotonia, ligamentous laxity, decreased strength and short limbs by developing compensatory movement patterns which, if allowed to persist, often develop into orthopedic and functional problems. The goal of physical therapy is to minimize the development of the compensatory movement patterns that children with DS are prone to develop.
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