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Winders, PT
What is the goal of physical therapy for children with Down syndrome?
Home Program
Daily practice and repetitions build strength and motor plan Practice when child is at his/her best Prioritized activities Customized to family and built into daily routines
Steps
Walk on squishy surfaces Walk on grass Walk on sand Walk on sidewalk with cracked, uneven pavement Walk on wood chips Walk on gravel
Guidelines
Practice within childs tolerance Give hand support, then let go Choose flat surfaces Check protective reactions Footwear
Kicking a ball
The goal is: To kick a ball 10-20 feet
Steps
Kick a ball with two hand support Kick a ball with one hand support Kick a ball without support Kick a ball with hip flexion and knee extension
Guidelines
Choose ball of appropriate size/weight Kick with the leg child chooses Provide verbal, visual, tactile cues Surface and space Footwear
Running
The goal is: To run 100 feet in 15 seconds
Steps
Fast walking with two hand support on level surfaces Fast walking down an incline Fast walking swinging one/both arms for momentum Fast walking 100 feet in 25 seconds Run with two-hand support, leaning trunk forward Run 100 feet in 15 seconds
Guidelines
Moving fast Use even surfaces and wide open spaces Hand support; let go Hand/arm support Verbal cues Build distance, speed and endurance Use running for breaks Footwear
Steps
Walk across 10 inch wide balance beam Walk across 7 inch wide balance beam Walk across 5.5 inch wide balance beam Walk across 4 inch wide balance beam
Guidelines
Make sure balance beam is stable Hand support; let go Verbal and visual cues Barefoot Readiness Leave out balance beam for self exploration Use balance beams in the community
Steps
Walk up/down small incline Walk up/down medium incline Walk up/down large incline
Guidelines
Vary angle and length Walking up is easier Walking down is harder Surface Verbal and visual cues Encourage walking vs. climbing Footwear
Guidelines
Lead with the foot the child chooses Identify whether up/down is easier Provide verbal and visual cues Surfaces Size of surface Encourage walking vs. climbing Height of curb vs. childs leg length Practice a variety of heights
Steps
Climb up/down stairs Walk up/down, marking time, with two hand support (forward or sideways) Walk up/down, marking time, with one hand support Walk up alternating with two hand support, then one hand support Walk down alternating with two hand support, then one hand support
Guidelines
Lead with the leg the child chooses Identify whether up/down is easier Give hand support; then let go Give verbal, visual, tactile cues Railing Begin with a few stairs Use carpeted stairs Use stairs 3-6 inches high Height of child vs. stair
Jumping
The goals are: 1. To jump in place 2. To jump forward 3. To jump off a stair
Steps
Bounce on a springy surface with feet flat with hand support Bounce on a springy surface on tiptoes with hand support Bounce on a springy surface and lift feet off surface with hand support Jump on the floor and lift feet off the surface with/ without hand support Jump forward 8 inches with/without hand support Jump off 4-8 inch step with both feet together with/without hand support
Guidelines
Provide verbal, visual and tactile cues Hand support Footwear Practice for short periods AAI Continue jumping activities
Riding a Tricycle
The goal is: To ride a tricycle using pedaling and steering
Steps
Climb on/off Scoot forward on a riding toy and steer Ride a tricycle with support to pedal and steer Steer and pedal a tricycle down an inclined surface Steer and pedal a tricycle on a level surface 15 feet
Guidelines
Choose traditional tricycle, not Big Wheels Size of tricycle Limit the accessories Practice when and as long as child chooses Provide verbal, visual and tactile cues Use smooth surface and open space
Skill Walk up 4 inch curb Walk down 4 inch curb Walk up stairs marking time Walk down stairs marking time Walk across 7 inch balance beam Fast walk 100 feet in 25 seconds Walk up 8 inch curb Walk down 8 inch curb Run 100 feet in 15 seconds Jump Walk up stairs alternating feet Ride tricycle 15 feet Walk across 4 inch balance beam Walk down stairs alternating feet
Avg 36 35 39 40 38 37 49 47 52 47 56 61 64 81
St D 12 12 9 10 9 12 13 12 11 12 10 11 25 21
NormRng 24-48 23-47 30-48 30-50 29-47 25-49 36-62 35-59 41-63 35-59 46-66 50-72 39-89 60-102
Shoe
Very flexible in toebox area Firm heel counter Broad rounded toe box Firm medial counter Flat bottom Not high top
Foundation needed: Once established, then practice what Leg and foot posture Walking pattern the child likes to do Trunk posture to further develop:
Shoulder girdle posture
http://www.coloradoballet.org/education/daretodance