PRESENTATION
ON
DOWN
SYNDROME
M. ARUN KUMAR , B.O.T
Occupational therapist
Down syndrome is a genetic disorder that causes lifelong
mental retardation, developmental delays and other problems. ,
Down syndrome occurs when there is an extra copy of
chromosome 21. This form of Down syndrome is called Trisomy
21. The extra chromosome causes problems with the way the
body and brain development
Common physical signs
Decreased muscle tone at birth
Excess skin at the nape of the neck
Flattened nose
 Separated joints between the bones of the skull (sutures)
Single crease in the palm of the hand
 Small ears
 Small mouth
 Upward slanting eyes
 Wide, short hands with short fingers
 White spots on the colored part of the eye (Brushfield spots)
 Birth
defects involving the heart, such as an atrial
septal defect or ventricular septal defect
 Dementia may be seen
 Eye problems, such as cataracts (most children
with Down syndrome need glasses)
 Early and massive vomiting, which may be a sign
of a gastrointestinal blockage, such as
esophageal atresia and duodenal atresia
 Hearing problems, probably caused by regular
ear infections
 Hip problems and risk of dislocation
 Long-term (chronic) constipation problems
 Sleep
apnea (because the mouth, throat, and
airway are narrowed in children with Down
syndrome)
 Teeth that appear later than normal and in a
location that may cause problems with chewing
 Underactive thyroid (hypothyroidism
ROLE OF OCCUPATIONAL THERAPY FOR
CHILDREN WITH DOWN SYNDROME
 self care skills (feeding, dressing, grooming etc.)
 fine and gross motor skills
 skills related to school performance (eg: printing,
cutting etc.)
 Psycho-social adjustment through games and
interactive projects, games, plays, and other
activities.
FINE AND GROSS MOTOR SKILLS
REACH : Movement and stabilization of the arm and hand
trunk rotation, full elbow extension, slight forearm
rotation, and wrist stability, some degree of excess
finger extension.
GRASP: Attainment of an object with the hand
along with reach thumb may be held flexed or
abducted to other fingers
CARRY:
Transporting a hand held object from one place to another
Frequently the forearm position and the wrist
positionmust be able to be modified during the
carry so the object remains in an optimal position.
Also shoulder rotation patterns simultaneous with
shoulder flexion and abduction.
RELEASE: The intentional letting go of a hand –held object
To place an object for release, the arm needs to
move into position accurately and then stabilize as
the fingers and thumb extend.

IN-HAND MANIPULATION: The adjustment of an object within
the hand after grasp
BILATERAL HAND USE: Use of two hands to gather to
accomplish an activity
Ex- ball throwing skills
child must bring the arm into a starting position,
Then prepare for projection of the ball into space by
moving first the trunk with the scapulohumeral joint
then stabilize the shoulder while beginning to extend the
elbow
Then stabilize the elbow while moving the wrist from
extension to a neutral position and simultaneously
forcefully extending the fingers and thumb
1. TRUNK AND NECK CONTROL
PRONE EXTENSION
 SUPINE FLEXION
 TRUNK ROTATION
2. SHOULDER AND ARM STABILITY
3.BIMANUAL COORDINATION
4.FUNCTIONAL GRASP
 FOREARM SUPINATION
 WRIST STABILITY
 ARCH DEVELOPMENT
 RADIAL-ULNAR DISSOCIATION
 OPEN WEB SPACE
 THUMB OPPOSTION
 IN-HAND MANIPULATION

TRUNK AND NECK CONTROL:
Strong trunk and neck muscles allow the child to sustain an
upright posture and hold up the head and shoulders against
gravity.
PRONE EXTENSION:
The child supports the body on the abdomen(stomach) in a prone
position.
ACTIVITIES:
 prone position on a scooter board


swing, spinning board
coloring, looking at books, playing board games

Adaptive positions used
SUPINE FLEXION:
Supine flexion involves lying on the back in a supine
position.
ACTIVITIES:

Children can reach high with their hands for objects like
balls,balloons,bean bags .
Can kick, touch, lift objects with their feet
 Abdominal exercises

TRUNK ROTATION:
Trunk rotation requires use of trunk extensor and flexor
muscles.
ACTIVITIES:
 Sitting /standing on ball and put rings

Sitting on balance board do rotation
SHOULDER AND ARM STABILITY:
Shoulder stability adds to the trunks base of support, which is
needed for hand mobility.
ACTIVITIES:
 Attach push pins to a cork board on a wall. Loop colorful
rubberbands around the push pins to make patterns
 Coloring
BIMANUAL COORDINATION:
Both hands must be used smoothly together for handwriting
ACTIVITIES:
clay activities, ball thronging
FUNCTIONAL GRASP:
FOREARM SUPINATION;
An efficient pencil grasp the forearm is neither palm down nor palm up. partial
suspiration (partial palm –up )
ACTIVITIES:
 Nut and bolts, clapping hands on the legs palm up and palm down in
rhythmic patterns

Using a toy screwdriver
WRIST STABILITY:
An efficient pencil grasp requires stability and 30 degrees
of wrist extension
ACTIVITIES:
 Beads ,clay activities
ARCH DEVELOPMENT:
Transverse
(side to side)
longitudinal
oblique
(fingertip to wrist)
(diagonal)
ACTIVITIES:
 Manipulating pegs of varying sizes

cupping round objects in the palm

shake dice,rice,marbles

Pulling tiny objects with the thumb and little finger
RADIAL-ULNAR DISSOCIATION:
Stability on the ulna side (little finger) of the hand supports
the skilled movements on the radial side(thumb) of the
hand.
ACTIVITIES:
 Using tools ,such as hairbrushes,toothbrushes,play
hammers, drum sticks or play screwdrivers

Using toy scissors

Operating any squeeze or pump spray bottle or squirt
gun

Pulling ropes, tubing and thick objects
OPEN WEB SPACE
An open web space(the loose skin between index finger and thumb)in a pencil
grasp allows nerves to send accurate sensory-motor information between
the tips of thumb, index finger and middle finger, and the brain.
ACTIVITIES:
 Weight bearing on an open hand

Gripping or holding wide, hand-sized objects such as a cup, large block
THUMB OPPOSITION
• In an efficient pencil grasp the thumb rotates toward the little
finger resulting in the tip of the thumb moving opposite the
tip index finger
ACTIVITIES:
 Using a toy requiring the thumb to push a button opposite
the index and middle fingers.

Pulling tiny objects out of putty or clay
IN-HAND MANIPULATION
TRANSLATION -FINGERS TO PALM
ACTIVITIES:
 Getting a coin out of a change purse

Crumpling paper

Picking up and bringing small piece of food into the palm
TRANSLATION-FINGERS TO PALM WITH STABILIZATION
 Getting two-or more coins out of a change purse, one at
a time

Picking up pegs or paperclips one at a time to hold two
or more in the hand at one time


TRANSLATION-PALM TO FINGERS:
Moving an object to put it into a container
Moving a food item to put it in the mouth
TRANSLATION-PALM TO FINGERS WITH STABILIZATION
 Putting one utensil down where holding several


SHIFT
Turning pagers in a book
Picking up sheets of paper, tissue papers

Separating playing cards

String beads
SIMPLE OR COMPLEX ROTATION
 Removing or putting on a small jar lid

Putting on or removing bolts from nuts

Rotation of a crayon or pencil
GROSS MOTOR SKILLS
Movement of the large muscles in the arms, and
legs.
Abilities like
 Rolling
 Crawling
 Walking
 Running
 Jumping
 Hopping
 Skipping
Tumble crawl
Therapy ball activities
vestibular dome
Balance beam
Walking
balance board
climbing wall
Foam steps
Balance bar
Barrel activities
Rotation board
tunnel
WHY ARE GROSS MOTOR SKILLS IMPORTANT
FOR STUDENTS?
 Gross
Motor skills and mastery of the large
muscle groups provide the foundation for
movement, coordination and balance.
 Safety, in the classroom, on the
playground, and in the gym.
 Gross Motor Skills build the foundation for
fine motor skills: If a child has difficulty
sitting in a chair, writing and coloring will
be more of a challenge.
ACTIVITIES OF DAILY LIVING:
Self – care skills like daily
 Brushing
 Toilet tasks
 Bathing
 Grooming
 Dressing
 Feeding
Brushing
Step by step method
Initially with physical and verbal prompt
slowly reduce prompt.
1.Get your toothbrush

2. Put toothpaste on
3. Brush upper surface of lower teeth
4. Brush outer surface of lower teeth
5. Brush inner surface of lower teeth
6. Brush outer surface of upper teeth
7. Brush inner surface of upper teeth
8. Spit
9. Rinse
10. Clean-up
Bathing
1.Take water
2. Pouring water over chest
3. Pouring water over left shoulder right shoulder
4. Applying soap over chest left hand left leg right hand
right leg back
5. Rubbing all the body part
6. Pouring water
7. Weeping
Dressing frames

1.
Dressing On/Off
On lap method identifying front and back of the
shirt or T-Shirt.
For T-shirt
On/Off lower Garments
Eating
Grooming
Putting shoes
VOCATIONAL

REHABILITATION
PAPER BASED WORK
Book binding
Paper bags preparation
greeting cards making
CRAFT AND TAILORING
glass painting
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•
•
•
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

•
embroidery
soft toy making
block painting
fabric painting
DOMESTIC ACTIVITY
Tea and snacks preparation
Chocolate preparation
Chain making
gardening
AIDS TO DAILY LIVINGS
Cross over grip
bip gip
built-up handle
Long handled brushes and combs
zip grips