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Commentary on Does Orthotic Use Affect Upper Extremity Support During Upright Play in Infants With Down Syndrome?

Womack, Barbara PT, MA; Heriza, Carolyn B. PT, EdD, FAPTA

Pediatric Physical Therapy: April 2011 - Volume 23 - Issue 1 - p 1
doi: 10.1097/PEP.0b013e31820991c3

Kid-Ability Mobile Pediatric Physical Therapy, LLC, Phoenix, Arizona

Doctoral Programs in Pediatric Science, Rocky Mountain University of Health Professions, Provo, Utah

“How could I apply this information?”

This study compared the use of upper extremity support in standing in 2 groups of infants with Down syndrome (DS) who were preambulatory from the onset of pull to stand until taking 3 independent steps. Both groups received treadmill training for 8 minutes a day 5 days per week. The experimental group wore supramalleolar orthoses (SMOs) and the control group did not.

  • Orthotic use did not have an effect of decreasing the use of hand support in standing play. Children without SMOs more successfully used a strategy of leaning against a support to free up 1 or both hands for play than those wearing SMOs. The former group also began to explore with 2 hands 2 months before the SMO group, perhaps giving them an advantage in learning.
  • Infants wearing SMOs benefited from more stability, decreasing their time leaning but increasing their time standing with hand support.
  • Over time, all infants decreased the use of hand support during leaning and nonleaning. The strongest effect on improved hand use for play and exploration was the passage of developmental time.
  • In both groups, standing time rapidly increased just before the onset of walking.

“What should I be mindful about in applying this information?”

  • This is the only study on the use of orthotics by infants with DS who are preambulatory.
  • Both groups received treadmill training. There was no orthosis-only group.
  • Only 1 type of orthotic was used, SureStep SMOs. Different orthotic types may have different developmental implications.
  • Most therapists treating infants with DS do not have access to treadmills. Would the results be different in more traditional early intervention programs?
  • Data were collected up to 13 months. Over this time period, infants were also learning and exploring in other positions. Is there an effect of wearing or not wearing orthotics on other activities that may affect learning and mobility?
  • No information was provided on the home environment of the 2 groups. How might this influence outcomes?
  • Infants were tested playing at a Leap Frog Learning table for 20 minutes. Most infants do not spend this amount of time standing. If observations of spontaneous play and exploration were made over the same period of time, would wearing SMOs influence infants with DS to play and explore differently than a control group?
Copyright © 2011 Academy of Pediatric Physical Therapy of the American Physical Therapy Association