Pediatric Physical Therapy:
Section Information: Abstracts of Poster and Platform Presentations for the 2004 Combined Sections Meeting: Platform Presentations
Martin, Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN.
PURPOSE/HYPOTHESIS: Children with Down syndrome (DS) have gross motor delays and deficits in postural stability that persist into adolescence. Orthoses have been shown to improve postural stability in children with other diagnoses, but have rarely been studied with children with DS. The purpose of this study was to explore the effects of a flexible supramalleolar orthosis (SMO) on the postural stability of children with DS.
NUMBER OF SUBJECTS: Seventeen children with DS between the ages of 3 1/2 and 8 years were included in this study.
MATERIALS/METHODS: The children were tested 3 times over a 10-week period using the Standing dimension and the Walking, Running and Jumping dimension of the Gross Motor Function Measure (GMFM); the Balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); and the Activities Scale for Kids (ASK) questionnaire. A repeated measures design was used to collect data in the “shoes only” condition for all 3 sessions and in the “shoes + SMOs” condition immediately after fitting the SMOs and after 7 weeks of daily use. Range of motion measurements were used to explore the data for the influence of joint laxity. The GMFM and BOTMP data from 14 children were analyzed with 2-way analysis of variance (ANOVA). ASK questionnaire data from 13 children were analyzed with paired t tests. RESULTS: Significant improvement in the GMFM test scores was shown both at the time of fitting and after 7 weeks. For the BOTMP Balance subtest, significant improvement was seen at the end of the 7-week study period. Amount of joint laxity did not influence response to orthotic intervention. No difference in perceived physical disability was detected by the ASK questionnaire.
CONCLUSIONS: Children with DS between the ages of 3 1/2 and 8 years showed both immediate (day of fitting) and longer-term (after 7 weeks of use) improvement in postural stability with the use of flexible SMOs.
CLINICAL RELEVANCE: Postural stability was improved through relatively short-term use of flexible SMOs. The flexible SMOs are thought to improve proprioceptive feedback and midline positioning. In addition, the design of the SMO used in this study may allow a child to continue to develop ankle strategy balance reactions. Further research is needed to confirm these theories. Clinicians should consider the use of flexible SMOs for young children with DS as a means to improve overall functional mobility.