Whole Body Vibration to Improve Balance/Strength and Down Syndrome

A randomized controlled study was published on 30 children with Down syndrome, where 15 children received physical therapy and 15 children received physical therapy and whole body vibration training. Both groups participated 3x/week for 6 months. The groups underwent stability testing and muscle strength testing before and after the 6 mos of the treatment program.

The results indicated the following:
1. Each group demonstrated significant improvements in stability indices and muscle strength after treatment.
2. significantly greater improvements were seen in the study group (whole body vibration) when compared with the control group.

The researchers concluded that "Whole-body vibration may be a useful intervention modality to improve balance and muscle strength in children with Down syndrome".

Reference:  Eid, Mohamed Ahmed.  Effect of Whole-Body Vibration Training on Standing Balance and Muscle Strength in Children with Down Syndrome.  American Journal of Physical Medicine & Rehabilitation., Post Author Corrections: October 8, 2014.  Published Ahead-of-Print

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Fine Motor and Cognitive Skills in Down Syndrome

The International Journal of Disability, Development and Education has published research on 12 adolescents with Down syndrome.  Each individual participated in the Corsi-Block tapping test (e.g., visual working memory), the Auditory Memory span test (e.g., verbal working memory) and the Tower of London test (e.g., cognitive planning), and motor control, measured by the Purdue Pegboard (e.g., fine motor control).  The results indicated the following:

• individuals with Down syndrome who had better performance in fine manual dexterity had better performance in cognitive planning and verbal working memory abilities.

The researchers suggest that individuals with Down syndrome will obtain benefits in cognitive control by participating in motor interventions.

Reference:  Chih-Chia (JJ) Chen, Shannon D.R. Ringenbach, Andrew Albert, Keith Semken . Fine Motor Control is Related to Cognitive Control in Adolescents with Down Syndrome.  International Journal of Disability, Development and Education. Vol. 61, Iss. 1, 2014

Partial Body Weight Treadmill Training in Children Under 6

A research review was published on treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay.  Five diverse studies were included on treadmill training in 139 children.  Data was only included from three studies because the 5 studies were so diverse.  These 3 studies all had outcomes of age of onset of walking or gross motor function.  The evidence suggested that treadmill intervention could lead to earlier onset of walking in children with Down syndrome but the evidence was not clear for children at risk of neuromotor delay.  Two of the studies included children with Down syndrome and the results were inconclusive.  There was insufficient evidence regarding treadmill intervention and gross motor function.

The researchers concluded that treadmill intervention may accelerate the development of independent walking in children with Down syndrome. Further research is needed on treadmill interventions in young children at risk for neuromotor delay.

Reference: Valentin-Gudiol M, Bagur-Calafat C, Girabent-Farrés M, Hadders-Algra M, Mattern-Baxter K, Angulo-Barroso R. Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay: a report of a Cochrane systematic review and meta-analysis. Eur J Phys Rehabil Med. 2013 Feb;49(1):67-91.

Research on Muscle Weakness in Down Syndrome

A recent research study using a mouse model was published in the American Journal of Physiology - Regulatory, Integrative and Comparative Physiology comparing the soleus muscle in mice with Down syndrome and mice without Down syndrome.

The results indicated that there was not a significant difference between the two groups of mice with regards to the force production of the muscle, muscle fatigue and muscle fibers.  There was not a clear indication of mitochondrial limitation between the two groups either.

There was a significant difference in muscle recovery between the two groups.   There was also  numerous altered pathways in Down syndrome muscle including the breakdown of proteins, metabolism of glucose and fat, and neuromuscular transmission.

The researchers concluded that the muscle itself is not responsible for muscle weakness in mice with Down syndrome and the perhaps the motor systems in the brain or the neuromusclar junction play a role in muscle weakness in Down syndrome. 

Reference:  Krupa, D. New Study Offers Insights Into Role of Muscle Weakness in Down Syndrome. Retreived on 12/28/12 from the American Physiological Society at http://www.the-aps.org/mm/hp/Audiences/Public-Press/For-the-Press/releases/12/44.html

Orthotic Use and Down Syndrome

A single subject, alternating treatment design was used to analyze the effectiveness of two different supramalleolar orthotics.  Two children with Down syndrome each participated in three phases: without orthotics, SureStep orthotic and the DAFO #4 orthotic.  Using the Gross Motor Function Measure, results indicated improvements in both children with the SureStep orthotic and child #1 also showed improvements with the DAFO #4.  After the study was completed, both families continued with the SureStep.

The researchers concluded that additional research needs to be conducted to determine the most effective orthotics and what age should the orthotics be introduced.

Reference: Tamminga, Janna S.; Martin, Kathy S.; Miller, Ellen W. Single-Subject Design Study of 2 Types of Supramalleolar Orthoses for Young Children With Down Syndrome. Pediatric Physical Therapy. 24(3):278-284, Fall 2012. doi: 10.1097/PEP.0b013e31825c8257

Wii Use and Down Syndrome

A case study was published in Pediatric Physical Therapy regarding a 12 year old with a diagnosis of Down Syndrome who followed a home program using the Wii. The 12 year old used the Wii 4 times per week for 20 minute sessions over a period of 8 weeks. The family was encouraged to participate. The 12 year old choose 4 different games to play. Following the 8 week period, the child exhibited improvements in "in the child's postural stability, limits of stability, and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition balance, upper-limb coordination, manual dexterity, and running speed and agility standard scores".

Would love to see this study replicated with a larger sample size. The Wii is so much fun and engaging. In my opinion, home programs could be easily set up with increased follow through with the Wii. More fun for the individual and less set up time for the parents.

Do you use the Wii in your practice?

Curious to hear if anyone is using Kinect and what your opinion is?

Reference: Berg, P et al. Motor Control Outcomes Following Nintendo Wii Use by a Child With Down Syndrome. Pediatric Physical Therapy: Spring 2012 - Volume 24 - Issue 1 - p 78–84. doi: 10.1097/PEP.0b013e31823e05e6

Bicycle Riding and Down Syndrome

Physical Therapy has published research on the effects of bicycle riding on children with Down Syndrome. Two groups of children with Down Syndrome ranging in age from 8-15 years old participated in the study. The experimental group was taught how to ride a bicycle over a five day period. The control group received no intervention until one year after the experimental group. Following the 5 day instruction, 56% of the children learned to ride a two wheeler bike. The children who learned to ride spent significantly less time in sedentary activities than the control group after 12 months. In addition, the bike riding group spent more time in moderate to vigorous physical activity. The amount of actual bicycle riding was not recorded during the study.

Reference: Dale A. Ulrich, Amy R. Burghardt, Meghann Lloyd, Chad Tiernan, and Joseph E. Hornyak. Physical Activity Benefits of Learning to Ride a Two-Wheel Bicycle for Children With Down Syndrome: A Randomized Trial. PHYS THER October 2011 91:1463-1477; published ahead of print August 18, 2011, doi:10.2522/ptj.20110061

Strength and Balance Training - Down Syndrome

A randomized controlled trial on strength and balance training in children with down syndrome was published in Clinical Rehabilitation . Twenty three children with Down Syndrome were divided into two groups - an experimental group who received 6 weeks of progressive resistive exercise and balance training and a control group (no intervention). The results indicated a significant improvement in lower limb muscle strength in the experimental group. In addition, a significant improvement in balance scores on the Bruininks Oseretsky Test of Motor Proficiency (BOTMP)were also seen in the experimental group.

Reference: Sukriti Gupta,Bhamini krishna Rao,and Kumaran SD Effect of strength and balance training in children with Down’s syndrome: a randomized controlled trial Clin Rehabil May 2011 25: 425-432, first published on November 8, 2010 doi:10.1177/0269215510382929

Orthotics Affect on Upper Extremity Use

The Spring 2011 issue of Pediatric Physical Therapy published an interesting study on the use of supramalleolar orthoses and how they affect upper extremity use. Seventeen children with Down Syndrome were divided into two groups of treadmill training - one group of children wore supramalleolar orthoses and the other group did not. Both groups of children were followed every other month to video tape the use of the upper extremities during table top play. The children were followed from when they could pull to stand until independent walking. The results indicated that wearing supramalleolar orthoses did not affect hand support while standing.

Reference: Looper, Julia PT, PhD; Ulrich, Dale PhD Does Orthotic Use Affect Upper Extremity Support During Upright Play in Infants With Down Syndrome? Pediatric Physical Therapy: Spring 2011 - Volume 23 - Issue 1 - p 70–77 doi: 10.1097/PEP.0b013e318208cdea

Treadmill Training, SMO's and Down Syndrome

Physical Therapy published research on the use of supramalleolar orthosis (SMO) and treadmill training in infants with Down Syndrome. Seventeen infants were assigned to treadmill training with SMO's or treadmill training without SMO's. The infants received 3 minutes of treadmill training until the infant was able to take 3 steps independently. One month following the motor skill acquisition of independently taking 3 steps the Gross Motor Function Measure was administered. The infants who did the treadmill training without the SMO's had higher scores on the Gross Motor Function Measure in standing, walking, running and jumping. The researchers concluded that the use of orthosis may have a "detrimental effect of overall gross motor development".

Reference: Looper, Julia, Ulrich, Dale A. Effect of Treadmill Training and Supramalleolar Orthosis Use on Motor Skill Development in Infants With Down Syndrome
PHYS THER 2010 0: ptj.20090021

Sensory Motor Groups in Children with Down Syndrome

The current issue of Pediatric Physical Therapy has published research on sensory motor groups for children with Down Syndrome. The researchers compared 2 groups of children with Down Syndrome (10 children total ages 13-29 months of age). One group received only individualized interventions and the other group received the individualized interventions along with 10 weekly sessions of a sensory motor group. Children in the cluster that received the weekly sensory motor group interventions exhibited significant improvements on the Gross Motor Function Measure in the following sections: lying and rolling, kneeling and total score. Significant improvements were also seen in Goal Attainment Scaling. The researchers concluded that sensory motor group interventions resulted in greater improvements when compared to only individualized interventions. They recommended further research in this area.

For sensory motor group activity ideas check out Sensory Motor Group Activities A to Z. Need activity ideas in a hurry - 25 Instant Sensory Motor Group Activities.

Reference: LaForme Fiss, Alyssa C. PT, PhD, PCS; Effgen, Susan K. PT, PhD; Page, Judith PhD, CCC-SLP; Shasby, Sharon PhD, OTR/L Effect of Sensorimotor Groups on Gross Motor Acquisition for Young Children with Down Syndrome. Pediatric Physical Therapy. 21(2):158-166, Summer 2009.