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What is Down Syndrome?
Signs and Symptoms
How Is It Diagnosed?
The average lifespan of a person with DS today, in America and in other developed countries, is
approximately 60 years. Although DS continues throughout a person's lifespan, children and adults can
improve their ability to perform movement activities and everyday tasks with the help of physical
therapists and other health care professionals. Physical therapists can help prevent some of the
complications of DS such as developmental delay, obesity, and lower levels of heart or cardiovascular
fitness.
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Down syndrome usually is detectable at birth by the baby's physical characteristics. These physical
characteristics include:
Low muscle tone
A single deep crease across the palm of the hand
A slightly flattened facial profile, and an upward slant to the eyes
A chromosomal analysis will be done to confirm the diagnosis.
Almost 50% of babies born with DS will have some type of congenital heart disease, which may be noted
at the time of birth or soon after. Natural development is often delayed because the baby has low muscle
tone, decreased strength, increased movement at the joints, poor balance, posture difficulties, feeding
problems, and poor hand use. Children with DS also often require increased time to learn complex
movements, such as riding a tricycle.
Additional symptoms as the baby develops include:
Poor language development and language use
Vision and hearing problems
Intellectual disability
Possible misalignment of bones at the base of the head and compression of the spinal cord
In later childhood and adulthood, people with DS may develop other symptoms, such as:
Low motivation
Difficulty learning complex movement tasks
Obesity
Poor cardiovascular health
Thyroid dysfunction/diabetes
Skin disorders
Sleep apnea
Depression
Early onset of dementia
Physical therapists will work with the family and other health care providers to reduce or prevent these
symptoms. Good medical care, strong educational environments that include therapy from preschool
through high school and into adulthood, and support from families can help keep adults with DS as
healthy as possible. Many adolescents and adults with DS participate in family and community activities
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How Is It Diagnosed?
Three types of DS have been identified, and all types are diagnosed by a chromosomal analysis,
frequently a blood test, ordered by a physician.
Type 1. The most common type of DS is called "Nondisjunction Trisomy 21." This type of DS occurs
when 3 copies of chromosome 21 are present in the fertilized egg. Typically, one copy of chromosome
21 comes from the father and one copy from the mother. When 3 copies are present, the extra
chromosome may come from either the mother or the father. As the baby develops, the extra
chromosome is copied into every cell in the body.
Type 2. Translocation Trisomy 21 is seen in about 4% of all people with DS. In this type of DS, part of
chromosome 21 breaks off during cell division of the fertilized egg and attaches to another chromosome.
The total number of chromosomes in the cells is the usual 46, but the extra part of chromosome 21
causes the baby to have the characteristics of DS.
Type 3. Mosaic Trisomy 21 occurs in about 1% of persons with DS. This type of DS occurs when a
"nondisjunction" of chromosome 21 takes place in 1 of the cell divisions of the fertilized egg, but not all
cell divisions are affected. Some of the baby's cells contain 46 chromosomes, which is typical, but other
cells contain the extra chromosome 21 for a total of 47. People with Mosiac DS may have fewer
characteristics of the syndrome.
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observing movement patterns; making a hands-on assessment of muscle strength, tone, and
flexibility; and testing the child's balance and coordination.
Motor development tests. The physical therapist will perform specific tests to determine the
child's motor development, such as sitting, crawling, pulling up to standing, and walking. The
physical therapist also may screen the child's hand use, vision, language skills, intellect, and other
areas of development.
Referrals. The physical therapist may refer you to other health care professionals who can
participate in a team effort to address the child's needs.
The physical therapist is an important partner in health care and fitness for anyone diagnosed with DS.
Therapists help people with DS to gain strength and movement to function at their best throughout all
the stages of life.
Therapy may be provided in the home or at another location such as a community center, school, or a
physical therapy outpatient clinic. The physical therapist will work with other health care professionals,
such as speech/language pathologists or occupational therapists, to address all the individual's needs
as treatment priorities shift.
Specifically, physical therapists work with children with DS to improve muscle strength, balance,
coordination, and movement skills to improve daily activities and quality of life. The purpose of early
intervention is to prevent a child with DS from developing atypical movement patterns.
Improving strength. The physical therapist will teach you and the child exercises to increase
muscle strength. The therapist will identify games and fun tasks that improve strength. As the child
grows, the therapist will identify new games and activities to reduce the risk of obesity and
increase heart health.
Improving developmental skills. Your physical therapist will help your child learn to master
motor skills such as crawling, pulling to standing, and walking. Research has shown that infants
with DS can benefit from such activities as walking on a treadmill. Physical therapists can help
caregivers support their child's movement development by providing hands-on training for
positioning, movement, feeding, and play. Your therapist also may suggest changes at home to
encourage movement development, communication, hearing, vision, and play skills.
Improving balance and coordination. The physical therapist may use equipment such as a
firm, round pillow or an exercise ball to improve the child's ability to hold the head erect or to
maintain a sitting position. Bilateral coordination skills, such as jumping, skipping, and dribbling a
ball may be incorporated into therapy.
Improve physical fitness. The physical therapist will help determine the specific exercises, diet,
and community involvement that can promote healthy living choices and prevent complications of
DS such as activity limitations and decreased participation with siblings or peers.
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Further Reading
The American Physical Therapy Association (APTA) believes that consumers should have access to
information that could help them make health care decisions and also prepare them for their visit with
their health care provider.
APTA has determined that the following articles provide some of the best scientific evidence on Down
syndrome. The articles report recent research and give an overview of the standards of practice for
treatment both in the United States and internationally. The article titles are linked either to a PubMed*
abstract of the article or to free access of the full article, so that you can read it or print out a copy to
bring with you to your health care provider.
US National Library of Medicine, MedlinePlus. Down syndrome. Available here. Updated February 16,
2013.
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US Department of Health and Human Services, National Institute of Child Health and Development. Down
syndrome overview. Availablehere. Updated November 30, 2012.
Smith BA, Stergiou N, Ulrich BD. Patterns of gait variability across the lifespan in persons with and
without Down syndrome. J Neurol Phys Ther. 2011;35:170177. Free Article.
Centers for Disease Control and Prevention. Facts about Down syndrome. Available here. Updated June
8, 2011.
Lana-Elola E, Watson-Scales SD, Fisher EM, Tybulewicz VL. Down syndrome: searching for the genetic
culprits. Dis Model Mech. 2011;4:586595. Free Article.
Bull MJ; Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics.
2011;128. Free Article.
Jones J, Hathaway D, Gilhooley M, et al. Down syndrome health screening: the Fife model. British J of
Learning Disabilities. 2010;38:59. Article Summary not Available.
Smith DS. Health care management of adults with Down syndrome. American Family Physician.
2001;64:10311038. Free Article.
National Down Syndrome Society. Early intervention and physical therapy resources. Available here.
Global Down Syndrome Foundation. Available here.
*PubMed is a free online resource developed by the National Center for Biotechnology Information
(NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National
Library of Medicine's MEDLINE database.
Authored by Venita Lovelace-Chandler, PT, PhD, PCS. Reviewed by theMoveForwardPT.com editorial
board.
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