1. Specialized Physical Therapy Training Programs for Children
with Down Syndrome: What Really Works? Shelby Romee
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Introduction
Methodology sldklsdf!
Recommended Intervention Description
& Rationale
Other Intervention Considered
Whole Body Vibration Training (WBV)
• Client stands, sits, or lies down on a machine with a
vibration platform (see picture below)
• Machine vibration transmits energy to body, forcing the
muscles to contract and relax dozens of times each second
(Mayo Clinic, 2014)
• May improve standing balance, muscle strength, and bone
mineral density/quality in DS children (Eid, 2015; Matute-
Llorente, 2015)
• Currently, studies of this newer specialized physical therapy
training program (2013) are limited and internal validity
and generalizability of findings is pending further research.
• Statistically significant results, but only under specific
conditions (with vision and somatosensory input altered)
(Villarroya, 2013)
• Multiple studies concluded that the
intervention “may be” or “might be” useful
(Eid, 2015; Matute-Llorente 2015)
• More research needed on WBV training
before adoption as an evidence based
practice.
Conclusion & Recommendations for
practice and research
Research Question:
What is the most effective
specialized physical therapy
training program for improving
development in children
diagnosed with Down
syndrome?
• Down Syndrome (DS) continues to be the most common chromosomal
disorder world-wide (Center for Disease Control, 2014)
• Each year, about 6,000 babies are born with Down syndrome, or 1 in
every 700 live births (Center for Disease Control, 2014)
• Physical development remains the underlying foundation for all
future progress in children diagnosed with DS (National Down
Syndrome Society, 2015)
• Physical therapy is necessary for this population to develop gross
motor skills to meet developmental milestones, and to prevent
compensatory movement patterns that individuals with DS are prone
to developing (National Down Syndrome Society, 2015)
• More evidence based specialized training programs are urgently
needed in addition to traditional physical therapy to provide patients
with more individualized and patient-centered health care.
A systematic search of the literature was conducted.
Databases Used: PubMed, Google Scholar, UH Library Database
Search Terms Used: Down Syndrome, AND (Children, OR Infants), AND
(Physical Therapy, OR Physical Therapy Training, OR Specialized Physical
Therapy Programs), AND (Treadmill Training, OR Whole Body Vibration
Training)
Inclusion Criteria:
• Peer Reviewed Articles
• Published in Academic Journals
• Empirical Study Design (Mostly
Randomized Controlled Trials)
Exclusion Criteria:
• Non-Down syndrome population
• Therapy used for Adults/Elderly
• Non-scientific articles (suggested
therapies)
A total of 6 intervention studies (3 for each specialized physical
therapy training program) were ultimately selected to determine which
of the two interventions was most effective for the target population.
Treadmill Training
What is it?
• A specialized form of physical therapy training administered by parents in the
home using custom-engineered treadmills (see picture below)
• An example of an average training regimen would be, children train for 8
minutes per day, 5 days per week at a treadmill speed of .2 meters per second
(Ulrich, 2001)
• During initial sessions children are on the treadmill for 1-minute intervals
followed by a minute of rest. Parents gradually increase the training intervals
until the child achieves 8 consecutive minutes of practice (Ulrich, 2001)
Why?
• Many well developed studies with high statistical significance have been
published since the introduction of intervention in 2001
• Almost all were randomized controlled trials possessing high internal and
external validities, making this a sound evidence based practice
• Intervention has been proven to significantly increase the onset of walking in
children with DS in multiple studies (Ulrich, 2001; Wu, 2007)
• Has also been proven to elicit more advanced gait patterns, particularly in
regards to stride length (Wu, 2007)
• Enables parents to take ownership of their children’s progress- one of the most
important elements in helping parents of infants with disabilities come to grip
with their situation (Ulrich, 2001)
• Earlier studies (Ulrich, 2001) of intervention found that those receiving
treadmill training had significantly better results in 3 categories of
developmental behaviors versus the control group (see Table 2 below)
Intensity
• More recent research has looked into the benefits of high vs. low intensity
treadmill training
• Higher intensity programs progressively increase treadmill belt speed and
increase daily training duration. One study added a small amount of weight to
the children’s ankles, proportional to their estimated calf mass and increased
the weight over the course of training (Wu, 2007)
• Children participating in higher-intensity treadmill training increased their
stepping more dramatically over the course of their training (Ulrich, 2007)
• These children also attained most of their motor milestones at an earlier
mean age (Ulrich, 2007)
• Other research confirms that higher intensity treadmill training promotes
significantly earlier walking onset as well as elicits more advanced gait
patterns (Wu, 2007)
• One study found that 6 basic gait parameters (average velocity, stride length,
step width, stride time, stance time, and dynamic base) improved
significantly with high compared to low intensity training (p=0.037) (Wu,
2007)
• Treadmill training is a more effective specialized physical
therapy training program than WBV training for improving
development in DS children.
• Importantly, although evidence-based studies on the superiority
of WBV training are limited, findings suggest that it may be
more effective than traditional physical therapy, and also
improves bone structure and quality (Matute-Llorente, 2015)
• Combining both therapies warrants further research to assess
the synergistic effect of both therapies in improving to
development outcomes in DS children.
• The urgent need for more evidence based DS training programs
requires further innovative research to identify more effective
and integrative strategies to improve these children's
development and overall well-being.
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