Victoria Wood OTR/L

Occupational therapists (OT practitioners) provide skilled services to help many different people, with or without a diagnosis. In this article, we will talk about Down syndrome, more specifically common interventions and strategies when providing occupational therapy for Down syndrome.

Occupational Therapy For Down Syndrome

Occupational therapy practitioners work with many diagnoses. In pediatrics, the diagnosis of Down Syndrome may be seen in early intervention services, in school-based therapy, or in the outpatient setting.

An occupational therapist will perform an evaluation and develop an individualized plan of action designed to meet specific needs. Occupational therapy interventions may be related to areas such as:

• Oral motor concerns impacting feeding
• Positioning and feeding techniques
• Physical motor skills including gross and fine motor skills
• Achievement of motor milestones including rolling, sitting, position changes, and use of the arms and legs, etc.
• Facilitation of self-care skills
• Refinement of fine motor skills
• Sensory needs
• Social or emotional needs
• Self-regulation needs

This list may not include every area addressed in occupational therapy. Let’s go into more detail about OT and the individual with Down syndrome.

First, let’s cover the diagnosis of Down syndrome.

WHAT IS DOWN SYNDROME?

Down syndrome is a genetic disorder caused by additional copy of chromosome 21. In regard to functional performance, the typical characteristics of Down syndrome include:

• Low muscle tone
• Relatively short limbs, including hands, fingers, and thumbs
• Mild to moderate intellectual disability
• Developmental delays

People with Down syndrome are often active members in their communities, able to participate well in school and social events, and can raise a family. Each case is unique, and health professionals such as occupational therapists are available to help improve functional independence along the way. 

what is Occupational therapy for Down syndrome?

In order to fully understand the involvement between the occupational therapist and person with Down syndrome, it is critical to learn the role of the OT.

During the initial evaluation of a person with Down syndrome, the occupational therapist will assess many different skills to determine the specific needs. They will try to answer broad questions like, “How independent is the person with activities like eating, dressing, and playing?”, and specific questions, such as, “What types of grasps do they use?”.

Developmentally appropriate assessments will be used to measure fine and gross motor skills, cognition, and sensory regulation. 

down syndrome: Fine Motor Skills

The whole body is responsible for strong fine motor skills; starting with core then shoulder strength, moving down toward strength and mobility in the hands and fingers.

The general decrease in muscle tone and joint stability that is common in those diagnosed with Down syndrome, makes the development of fine motor skills more challenging. 

Physical features impacting fine motor skills

The hands of a child with Down syndrome have a typical pattern of development, including shorter hands, fingers, and thumb than the average child, that can further decrease dexterity.

The palms may also lack the curvature that is required for skills like thumb opposition. We call these the arches of the hand, and they are useful during any skill that requires the hand to move around an object, big such as a water glass, or small like buttons. 

Because of these physical features, coupled with general muscle weakness and loose joints, occupational therapy for Down syndrome will likely offer activities to increase fine motor skills.

Gympanzees has a great article on developing fine motor skills for children with Down Syndrome.

Dexterity and Down Syndrome

• Use small items, like beads/pompoms/Cheerios/buttons, to pinch, place, string, glue down, or count.
• You can increase the challenge by encouraging holding onto multiple items in one hand, but only placing one at a time – much like we hold a set of coins and use a singular hand to find and place the correct coin. This is referred to as in-hand manipulation. 

Joint Protection and down syndrome

• Braces or splints may be used to help support the joints in a functional position, while the child continues to build strength. 

Arm Strength and down syndrome

• Weight bearing through the arms is a great way to build shoulder strength for fine motor development – try animal walks, wheelbarrow walking, or crawling through tunnels!

Hand Strength and down syndrome

• Get those fingers moving by shaping playdough or putty; roll, squeeze, poke, smash, and pinch it! Increase the challenge as the skills develop by selecting firmer putty or by adding additional steps to the activity. 
• The OT Toolbox has great resources for overall fine motor hand development

Gross Motor Skills for down syndrome diagnosis

Just like fine motor skills, the base of gross motor skills is the core. A person needs that proximal stability first, before they can build movement skills.

Increasing the core strength leads to improved balance, coordination and dynamic movement control. These areas are addressed as they impact functional participation in feeding, self-care, learning in the school setting, and participation in functional tasks.

Individuals with Down syndrome tend to have a more challenging time with strength and motor planning to move from one posture to the next due to low tone.

For example, moving from a seated position on the floor to standing. The sequence should be: seated on the bottom, to a 4-point crawl position, to kneeling, to a single leg kneels, then standing. This sequence and combination of movements may pose an extra challenge due to limited mobility, strength, and muscle tone.

Below are some ways to improve occupational therapy for Down syndrome can improve gross motor skills. 

Core Strength and down syndrome

• There are so many play-based activities that strengthen the core. Almost any activity can be done in prone (on the tummy), which can improve core strength and offer some weight-bearing in the arms at the same time
• When you think core strength, think balance. Use balance beams, one-foot stand, wobbly surfaces, etc. Just make sure to prioritize safety and comfort. 

Positional Changes and down syndrome

• The more change, the better. Set up a game or obstacle course that encourages movement up/down, side-to-side, rolling, or scooting.
• The most important goal is to get that body moving!

down syndrome and Sensory Regulation 

Are children with Down syndrome more or less likely to experience sensory differences? Yes. This is the reason occupational therapy for Down syndrome and sensory regulation will be an important part of the treatment process.

There is one clear reason why people with a diagnosis of Down syndrome may experience more sensory processing difficulties – low muscle tone again. Individuals with low muscle tone may have a harder time processing proprioceptive input. This is the sense that our muscles and joints pick up to tell the body where they are in space. 

Because of this decreased proprioceptive input, people with Down syndrome frequently need more input in order to grade the force of their movements.

For example, they may experience difficulties in choosing how hard or how soft their movements should be. They may knock something down by pushing too hard, or drop something by mistake by not holding tight enough. 

This can also skew how an individual with Down syndrome eats food. They may not feel the food in their mouth very well until it is full, and start over-eating or pocketing food in their cheeks. People diagnosed with Down syndrome often grind their teeth as a way to get more input and stability through the jaw.

• Increased proprioceptive input
  • Weighted items: vests, lap pads, blankets 
  • Exercise, weight bearing, jumping 

In addition to low tone, another common comorbidity to Down syndrome is hearing loss. This is important to address as a sensory need because an individual may react strongly or under react to auditory stimuli. Sensory tools should be trialed for a few weeks to see what will work best to regulate the child’s sensory system. These tools should be used intermittently throughout the day, and never forced on a child. In order to be effective, they should be voluntary and not be used as a reward or punishment. 

• Auditory Processing Strategies 
  • Noise reducing headphones
  • Auditory feedback tube (like this)
  • Assistive technology for hearing loss

A Sensory Diet is a great treatment option for sensory processing and Down syndrome. The OT Toolbox also has a great resource called the Sensory Lifestyle Handbook to address and understand sensory processing needs.

For more play-based ideas for early intervention for working with learners with Down syndrome, here is a fun article on outdoor sensory activities.

If you are a fan of the OT Toolbox, you can access all of these resources much easier by becoming a member. As a member, you will:

• Be able to download each of them with a single click (No more re-entering your email address and searching through folders!)
• Receive early access to new printables and activities before they’re added to the website (You’ll find these in the What’s New section.)
• Receive a 20% discount on all purchases made in the The OT Toolbox shop!

For all of these skills, the most important part of occupationl therapy for Down Syndrome is to meet the child where they are. An Occupational therapist will make an assessment of their learner’s current level of functioning, providing a “just right” challenge, that is motivating for that particular learner. Because of potential delays in cognitive ability, and the physical difficulties associated with Down syndrome, these new skills may not develop quickly, and may not progress at all. Occupational therapy can help with adaptations to approach these tasks in a different way, or modifications to the environment to increase independence. 

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.