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Alerting and Preparing Activities for Children with
Down Syndrome
Levels of alertness can be influenced by all the sensory systems, including
the tactile, vestibular, and proprioceptive systems. If we are feeling lethargic
and low in energy, often the best way to increase our energy level and alertness is to do a movement activity, such as getting up and going for a walk. It is
the same for children with Down syndrome. Self-directed movement in itself
is alerting to the nervous system. Movements that can be particularly alerting
and organizing for the nervous system include 1) those that involve changing
the position of the head in space (vestibular input), such as going on a swing,
and 2) movements that provide deep pressure through the joints (proprioceptive input), such as jumping rope.
These types of sensory input can temporarily change a child’s level of
alertness. They also provide good preparation for the body to learn a new motor task. Participating in vestibular and proprioceptive activities prepares the
nervous system for a more challenging activity, such as one that is just being
learned. I have a personal example of how this works. For a long time I tried
to help Sarah learn how to ride a bike the usual way: by helping her get on
and put her feet on the pedals and then holding the back of the seat of the
bike while she rode. However, I never seemed to be able to let go of the back
of the bike, as she wasn’t getting the feel of balancing the bike. Finally, I tried
putting her on a tire swing at the local park (which she loved); she swung
and spun around for ten or fifteen minutes. When we tried the bike after the
swing, she starting catching on to the balancing of the bike right away, and
I was able to let go. It seemed to me that the vestibular input helped prepare
her for the more challenging task of balancing the bike. This may not work for
every child, and every child may not need the input to learn to ride, but there
seemed to be a correlation that worked for us.
Sometimes children with Down syndrome have difficulty with self-regulation in the context of environmental and social expectations. For example,
they may seem lethargic and relatively unresponsive in the classroom, only to
quickly become overexcited during a social interactive game. If there is physical contact in the game, they may overdo it, grabbing and holding the other
children inappropriately. The adults watching aren’t sure how to respond.
They are glad that the child is finally interacting with the other children, but
the child’s difficulties understanding social protocol and regulating his inter-
Fine Motor Skills for Children with Down Syndrome n247
actions are limiting his success with the others. It seems that the child’s “window” of optimal alertness and responsiveness is small and that he is more often
under or over the optimum level. Because of the child’s cognitive delays and
difficulty reading social cues and responding accordingly, using a combination
of sensory strategies and behavioral approaches will probably be most helpful.
Profile: James
James is a twelve-year-old boy integrated into a regular classroom.
Although quiet and somewhat noninteractive with his peers in the classroom, he “comes alive” at recess, running around randomly and trying to
join games that are already going on in the schoolyard. Because he is moving
around from group to group and doesn’t understand the rules of the game,
he causes disruption, and the other kids don’t want him to join.
Recently, his teacher has recognized his need for structured movement
activities with heavy work input (proprioception) to help him be more organized in his play during recess. She organized a group of eighth grade students to set up a few activities to start off recess for James and some of his
classmates. They begin with a tug-of-war on the lawn and then play a game
of dodge ball with a larger inflated ball (so the kids won’t get hurt by the
ball). They follow this up with a game of shadow tag (the kids step on each
other’s shadow to “catch” them in tag), so there is no reaching, touching,
and grabbing, which is hard for James to both tolerate and initiate appropriately. James becomes more organized during these activities, and is more
alert and interactive afterward in the classroom.
Technology
There are many apps that are described under a “Sensory” heading on
app lists. Many of these apps provide simple, calming visual and/or auditory
input that may help some children to maintain a calm, organized state. The
Time Timer, mentioned above in the section on transitions, is available as an
app, as are some similar products. There are also several apps that provide
templates and visual options for preparing visual schedules and social stories.
GestureTek, video gesture control technology, responds to movement by
changing, moving, video patterns (often projected onto a floor). I have seen
many children become more animated, mobile, and interactive when engaged
with this technology.
It is beyond the scope of this book to list even a small sampling of the
apps that might be helpful for children, teens, and adults who have difficulties with sensory processing. However, there are many websites that list and
248 nSensory Processing
categorize useful apps for people with disabilities. Some of these are listed in
the Resources at the end of the book.
Snoezelen
Snoezelen is a concept that was developed by occupational therapists in
Holland. Snoezelen is a sensory environment that provides people with severe
disabilities the opportunity to enjoy and control a variety of sensory experiences. Snoezelen is usually set up as a room or part of a room, and usually
includes a variety of visual lighting effects (such as a bubble tube, fiber optics,
and a solar projector), soft sounds, and comfortable cushions, and it sometimes includes movement (such as a hammock), vibration, mirrors, and tactile activities. Some of the sensory experiences are soothing, while others are
stimulating. Only those experiences that are appropriate for the individual’s
needs should be used.
Research into the effects of Snoezelen on people with challenging conditions supports the findings that it can have a positive impact on mood, behavior, and relationships. These changes are seen over time, as the child or adult
spends time regularly in the Snoezelen
room, and is free to enjoy and control
the sensory experience without any expectations to perform or respond in any
particular way. The white rooms, which
have white floors and wall mats, can be
calming and organizing and can help
offset some of the more demanding aspects of a person’s day.
Snoezelen rooms are now available
in some clinics, hospitals, schools, and
residential and other facilities that serve
individuals with developmental and physical disabilities.
Supplies are available through Flaghouse. (See Resources.)