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In Attainment of gross motor milestones in children with Down syndrome in Kosovo – developmental perspective, Bequj, Jusaj, and Živkovi? (2017) found that the motor developmental sequence of children with DS is the same as children with TD; however, there is a delay in skill acquisition. This delay increases as the complexity of the skills increase. They attribute this increase in delay partially to “…the pathophysiological process in the cerebellum, change in its size, and disorders in central nervous system maturation, observed in children with DS notably after the 6th month of life.” (Bequj, Jusaj, and Živkovi?, 2017, p. 195). Another factor addressed in their article is the negative impact that ill health has on motor development in both DS and TD populations (Bequj, Jusaj, and Živkovi?, 2017). Children with DS commonly have multiple ongoing health issues to complicate their already difficult development (Bequj, Jusaj, and Živkovi?, 2017). The most interesting finding of this study was that physical therapy did not affect sooner motor development. Instead they suggest more research should be done regarding the value of physical therapy for more efficient motor skills to decrease compensatory movements which could cause additional orthopedic problems if left untreated (Bequj, Jusaj, and Živkovi?, 2017).
Frank and Esbensen (2015) help to produce some normal expectations for developmental milestone accomplishments among children with DS (Frank & Esbensen, 2015). Individuals with DS accomplish the same basic motor skill as those with TD (Frank & Esbensen, 2015). The difference increases as the age of the individual and complexity of the skills increase (Frank & Esbensen, 2015). The development of motor skills for individuals with DS is no different in the order of mastery and skills that are learned. It is just delayed, and the delay increases with age (Frank & Esbensen, 2015). Gross motor skills are less delayed than fine motor skills (Frank & Esbensen, 2015). There are well known age ranges for typical developing children (Frank & Esbensen, 2015). However, the age ranges for DS individuals are not as universally defined. In their research, Frank and Esbensen use the Bayley-3 assessment tool and parental observation to establish an age range of accomplishment for fine motor and self-care development for individuals with DS (see Table 1). This study establishes a much-needed guideline for care providers to structure therapy and evaluate development in self-care for maximal potential of independence.
Table 1. Fine motor and self-care milestones for individuals with Down syndrome

Note. Comparison of fine motor skills between TD children and DS children. Reprinted from “Fine motor and self-care milestones for individuals with Down syndrome using a retrospective Chart Review,” by K. Frank and A. J. Esbensen, 2015, Journal of Intellectual Disability Research, 59, p. 724. Copyright 2014 by the MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd. Adapted with permission.
Tudella, Pereira, Basso, and Savelsbergh (2011) studied the influence of postural body position in 3-12-month-old infants with DS. The purpose of this study was to identify a time frame for motor skill acquisition in the prone, supine, sitting, and standing positions for infants with DS (Tudella, Pereira, Basso, and Savelsbergh, 2011). They found that antigravitational postural body position motor skills were the most difficult and the delay of developmental acquisition increased (Tudella, Pereira, Basso, and Savelsbergh, 2011). This difficulty in antigravitational motor skills is caused by hypotonia, ligamentous laxity, and balance defects (Tudella, Pereira, Basso, and Savelsbergh, 2011). They concluded that intervention (physiotherapy) would reduce the delay of motor development compared to children with TD (Tudella, Pereira, Basso, and Savelsbergh, 2011). However, there was no comparison of DS infants without intervention in this study. A comparison of DS infants without intervention would give greater validity to their conclusion.
Popa & Dobrescu (2017), found that physical therapy (PT), in the form of exercise focused on muscle strength, can help improve balance and coordination in individuals with DS. This study looked at improvement of motor skills after the motor skill was acquired. They took children 6-13 years old evaluated their gross motor development with anamnesis and the Gross Motor Function Measure (GMFM) (Popa & Dobrescu, 2017). Then, they worked for one and a half years on exercise and followed up with re-evaluation (Popa & Dobrescu, 2017). The GMFM scores doubled after the PT (Popa & Dobrescu, 2017). It was concluded that physical therapy can significantly help children with DS after gross motor skills are already acquired (Popa & Dobrescu, 2017). This is different than other studies which focus on PT helping accomplish developmental milestones and the majority of these developmental milestones need to be acquired to participate in the exercise. Therefore, PT will increase muscle strength which will help children with DS to perform daily activities with more ease and precision.
In Comparative study: Parameters of gait in Down syndrome versus matched obese and healthy children, Elshemy looks at the influence of obesity on the spatiotemporal parameters of gait (2012). He found that there are significant differences in the gaits in each of the following categories: genetically obese children with DS, non-genetically obese children, and healthy (not obese) children (Elshemy, 2012). The children with DS had the slowest and most impaired gait (Elshemy, 2012). He found that the differences that obesity made in gait was exacerbated with the other conditions common to DS (Elshemy, 2012). In conclusion, Elshemy recommends obese and DS patients need rehabilitation and exercise to improve daily function and quality of life (2012).

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