Allied Services

Pediatric physical therapy is concerned with the examination, evaluation, diagnosis, prognosis, and intervention of children, aged birth through adolescence, who are experiencing functional limitations or disability due to trauma, a disorder, or disease process

Physiotherapy is often very useful for children with Down syndrome. Children with Down syndrome often have muscles that are weak and low tone, and lax or unstable joints. These factors can affect a child’s physical development such as rolling, sitting, crawling and walking. Physiotherapy can help children with Down’s syndrome avoid developing of compensatory patterns of abnormal movements. These problems can be avoided by the physiotherapists, by teaching your child the optimal movement patterns, so that they can strengthen the appropriate muscles. Physiotherapy treatment includes:

  • Exercise programmes
  • Postural advice
  • Strengthening and stretching exercises
  • Balance exercises
  • Working towards developmental milestones
  • Avoiding the development of compensatory patterns of abnormal movements.

Early pediatric physiotherapy for children with Down syndrome can help with the acquisition of motor skills and develop the strength to help maximize motor function. At the Emirates Down Syndrome Association, Early Intervention starts from three months of childbirth with one on one sessions where the specialist provides guidance and exercises necessary according to that age along with home programmes.

OT is one of the health professions concerned with evaluating and treating patients from different age groups who have problems in performing their jobs and their daily activities,
whether these problems are caused by any illnesses, injuries, physical disabilities, psychological disabilities, developmental or behavioral disorders. OT aims to elevate the health of individuals and groups through various methods of treatment which includes beneficial activities, therapeutic exercises and tools, assistive technology devices, these methods work together to increase the autonomy of the patients and enable them to perform their daily functions and rehabilitate them. (Jordanian Association for Occupational Therapy)

Occupational therapy mainly aims to increase the autonomy of people with
Down syndrome in the following areas:
Self-care skills (such as eating, dressing, caring, General appearance, personal hygiene etc).
Gross and fine motor skills.
Cognitive skills (including pre-writing skills).
Play skills that are appropriate with the child’s developmental age.

The golden period of learning which is the first five-years of the child’s life is considered really crucial, therefore starting occupational therapy from this age is valuable to maximize the benefits for the child. The intervention process begins with assessing the child’s skills, abilities and identify the strengths and weaknesses, so then the occupational therapist can develop a treatment plan to treat the child and reduce weaknesses in order to help the child reaches the highest levels of independence.
At this point the occupational therapist may participate in:

1. Dealing with feeding problems related to the movement of the mouth muscles, such as laxity and weakness in cheeks, tongue and lips muscles, consequently, it complicates the breastfeeding process in children with Down syndrome. Hence, the occupational therapist suggests better bodily positions and methods of feeding.

2. Help to facilitate the development of basic features of the child’s physical movement, specially, fine motor skills.

3. The occupational therapist also works closely with the physiotherapist
to help the child with his developmental milestones for the gross motor skills (
Such as sitting, crawling, standing, and walking). Also, the occupational therapist elevates the child’s fine motor skills by strengthening the arm and hands movements.

4. Some people with Down syndrome have problems in processing different sensory inputs such as (Tactile, Vestibular, proprioception, vocal, visual, olfactory) which might lead to problems in their occupational skills and might hinders their performance of daily activities.

• Preschool
When the child reaches his pre-school age, the child is trained to move independently and explore his environment, and this could be a result from providing him/her with opportunities that enhance the learning process and help develop the autonomous skills in performing the daily activities such as eating, wearing clothes, playing, interacting appropriately with other children and improving his overall motor skills.

In this stage, the occupational therapist may interfere:
1. to Facilitate the development of fine motor skills-
In this stage a child with Down syndrome might begin to develop his fine motor skills. By improving his hands and arm movement, but in many cases, the child needs occupational therapy to support his motor developmental skills. Children with Down syndrome can improve their fine motor skills by playing (coloring, opening and closing objects, picking and unlocking games of all shapes, sizes, piling and building manipulating and pressing the game button, and many more). A child with Down syndrome may face some additional challenges when learning fine motor skills as a result of muscular dystrophy and lack of flexibility in joint ligaments or because of the small size of hands.

2. Promote the beginnings of self-care skills
A therapist can help parents see progress and meet their expectations by simplifying skills and teaching them how to train their child. The occupational therapist can also suggest suitable positions for the child and provide suitable equipment for the child, such as using a specific dish or spoon when eating. These recommendations and suggestions might help the child to adapt to his condition better and enable him to be self-sufficient as much as possible.

• Entering the school stage:
When a child enters school, we help the child to adapt to the new habits, attend school meetings and plan educational programs for the child, and focus on discussing and communicating.
Help the child practice fine motor skills (such as writing).
Believe in the child’s ability to have future development and independence in activities.
Find extracurricular activities that would expose the child to a variety of social, educational and material experiences.

In this stage occupational therapy has many purposes such as:
– Facilitating the development of fine motor skills in the classroom by providing typing and writing courses and classes
– Environmental assessment (Such as table height, etc) to help the child adapt better to the school environment
– Create an educational program based on the child’s different abilities.
• Work stage:
Study and evaluate the capabilities of the individual with Down syndrome and find their preferences in work and search for the suitable and appropriate careers and work environments.

SLPs specialize in the evaluation, diagnosis and treatment of communication difficulties such as speech and language delay, voice disorders, and swallowing disorders related to Down Syndrome or any other disorder.
SLPs also play an important role in the diagnosis and treatment of autism spectrum disorder, hearing impairment, stuttering and dyslexia.

There are any Devices used in Speech and Language Therapy?
A group of Augmentative and assistive communication devices and others to enhance the communication process for Children with Down syndrome. They face many challenges in the speech processes and it is necessary that a Speech and Language Pathologist can help young children to start the communication process and improve the eligibility of speech. Most children with Down Syndrome learn to speak and use the spoken language as the primary way of communication but before they are able to learn to speak, they will have the ability to understand and communicate like physical and verbal imitation, non-verbal and verbal communication.

When should you start with a Speech and Language Pathologist? What is meant by early language intervention?
A Speech and Language Pathologist can be visited for an early intervention from infancy. The term Early Language Intervention is called for the services provided to the child from birth until the age of two years. The treatment provided may include vocal and linguistic stimulation accompanied by playing and feeding, oral motor exercises and other training techniques. Families must be present in the sessions as parents are the main teachers of speech and language for their kids. Speech and Language Pathology services are based on an integrated treatment plan for the same age group and maybe at home or center and it can be a part of teamwork including Physical and Occupational Therapists. There are Early Language Intervention Programs offered by the center and also provides different treatment services for eligible children under the age of two according to an individual treatment plan and depending on the evaluation. Most children with Down Syndrome are eligible for Speech and Language Therapy services and these services continue after the age of three years through individual sessions and follow-up with parents and support whether for school programs or external activities.

What other skills that help to improve the Speech and Language?
There are other skills that are important to achieve before Speech:
• The ability to imitate and echo sounds
• Role-exchange skills (can be learned from games such as hide and seek)
• Visual skills (looking at and distinguishing people and things)
• Hearing skills (listening to music, pronouncing and practicing phoneme for long periods of time)
• Touch skills (learn to touch and explore things in the mouth)
• Oral Motor parts moving skills (using the tongue and moving the lips)
• Cognitive skills (understanding the permanence of things and the causal relationship).
Parents can stimulate these skills at home and they can also seek help from specialists in treating speech and language disorders to learn the skills necessary to help their children.

How can parents help their child to learn to speak and communicate?
Parents are the main persons that a child interacts with from birth and they have a great impact in helping the child learn how to communicate. The home is the best environment in which the child acquires the skills of pre-pronunciation and communication previously mentioned.

Parents must do the following to develop their child’s skills:
• Remember that the language goes beyond the spoken words to teach the child a word or concept, the focus must be on communicating the meaning to the child through play or feeling (hearing, touching, seeing).

• Provide many models, the child needs to repeat words and events repeatedly to learn only one word, you must repeat what the child says and provide a model to help him establish the word in his mind.

• Providing models and real situations, so that communication is part of the child’s life, one of the parents uses realistic activities and situations and exploits them to learn their child a concept for example; when the child is eating food, the parents can teach the child the food labels or the names of body parts when showering or even simple concepts (under, In, on) when playing with him.

• Reading to the child, parents help their son to teach him new concepts by reading to him about it, taking neighborhood tours and explaining the daily situations.

• Track what the child wants, if the child shows his interest in something, person or an event, the parents must inform the child the appropriate word for that concept.

• There are many positive turning points that parents will notice on their child’s pronunciation. Upon hearing the child, he would respond with a familiar voice, distinguish people, interact with different sounds, make several of them, and launch special sounds to indicate his mother and father (Papa – Mama).

• Most children enjoy looking at the mirror by making sounds and bubbling. Parents can develop these skills and apply them effectively at home by attending intervention sessions, books, workshops, or with speech and language disorders treatment specialists.

When will the child be able to pronounce his first word?
It is not possible to determine the age at which a child with Down syndrome can pronounce the first word, but it usually begins with the use of individual words between the second and three years of age and the first word may take a form of sign language, not pronounced words because the majority of children with Down syndrome communicate from the age of Birth by crying and looking or using sign language. They show a desire to communicate because they know that crying or making sounds may affect the environment around them and bring them either help, play or draw attention.

Many children with Down syndrome understand the relationship between the word and the concept when they reach ten months and a year but, at that age, the child does not have sufficient neurological and motor skills that are qualified to help him speak, so it is very important to provide another system that helps the child to communicate and learn the language before he can speak.