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Background: Children with Down syndrome have sensory integrative dysfunction as a result of limited
sensory experience from lack of normal motor control. The aim of the present study was to compare the
effects of sensory integrative therapy alone, vestibular stimulation in addition to sensory integrative therapy
and neurodevelopmental therapy, on children with Down syndrome.
Methods: The present study was carried out at the Occupational Therapy Unit, School of Physical Therapy
and Rehabilitation of Hacettepe University. Forty-ve children who were diagnosed as having Down
syndrome by the Departments of Paediatric Neurology and Medical Genetics at Hacettepe University were
assessed and randomly divided into three groups. Sensory integrative therapy was given to the rst group
(n=15), vestibular stimulation in addition sensory integrative therapy was given to the second group (n=15)
and neurodevelopmental therapy was given to the third group (n=15). All children were evaluated with
Ayres Southern California Sensory Integration Test, Pivot Prone Test, Gravitational Insecurity Test and
Pegboard Test. The hypotonicity of extensor muscles, joint stability, automatic movement reactions and
locomotor skills were tested. Treatment programs were 1.5 h per session, 3 days per week for 3 months.
Results: When these groups were compared, statistically signicant differences were found in subjects
performance of balance on right foot-eyes open, pivot prone positionquality score and locomotor skills-front
tests (P<0.05). There were no signicant differences in the other tests (P>0.05).
Conclusion: The results of the present study showed that sensory integration, vestibular stimulation and
neurodevelopmental therapy were effective in children with Down syndrome. It was concluded that when
designing rehabilitation programs for children with Down syndrome, all treatment methods should be applied
in combination, and should support each other according to the individual needs of the child.
Key words
Down syndrome
consistent delay is observed in the acquisition of both
postural and voluntary components of motor control.7,8
The vestibular system plays a major role in the expression
of early motor behavior. Previous research has cited extensive
neural connections between the vestibular apparatus and the
motor system.9
Children with Down syndrome have sensory integrative
dysfunction as a result of limited sensory experience from
lack of normal motor control. Physical, cognitive and
sensory integration problems decrease the functional ability
of children in activities of daily living.911 Neurodevelopmental approaches, sensory integrative therapy and vestibular
stimulation have been used to improve function in children
with Down syndrome.8,1216
The aim of the present study was to compare the effects
of sensory integrative therapy alone, vestibular stimulation in
addition to sensory integrative therapy and neurodevelopmental therapy in children with Down syndrome.
Methods
Participants
69
Test definitions
Pivot prone position test (PPP)
70
M Uyangk et al.
Gravitational insecurity
Groups
Total
Group 1
Group 2
Group 3
15
15
15
No. subjects
Female
Male
7
6
7
8
9
8
Age (years)
(mean~SD)
9.60~0.51
8.67~0.45
8.53~0.50
The time of ten step forward walking (LS-f) and ten step
sideways walking (LS-s) on a straight line were recorded.
Pegboard test
Results
In addition to the sensory integration therapy applied in the
rst group, vestibular stimulation was applied to the second
group. These included:
1. Linear swinging: With platform swing in standing and
kneeling position, with T-swing and platform swing in
sitting position, with platform swing quadruped position and
with platform swing in prone and supine positions.
2. Developing equilibrium reactions: Push-pull and movement of the support surface on tilt board on sitting and
standing position, activities on therapy ball in prone
position, active maintenance of balance on stairs and ramps.
Down syndrome
Table 2 Comparison of pretreatment evaluations
Score
Tests
mean
ANOVA
SD
71
3.74
2.44
2.72
0.12
>0.05
1.38
1.24
1.41
0.62
>0.05
4.28
5.44
6.24
0.52
>0.05
4.85
4.77
4.65
0.34
>0.05
12.08
15.43
18.79
0.06
>0.05
0.77
1.19
1.25
0.84
>0.05
3.54
2.66
3.36
0.59
>0.05
5.90
6.49
4.62
1.15
>0.05
1.87
2.15
1.64
0.86
>0.05
2.47
1.72
1.62
0.12
>0.05
9.61
7.56
8.66
0.96
>0.05
7.78
8.94
9.18
0.39
>0.05
Tests
Score
mean
ANOVA
SD
2.64
1.80
1.57
1.02
>0.05
2.13
1.52
1.81
0.52
>0.05
2.75
10.76
5.46
4.40
<0.05*
7.76
11.13
4.17
1.80
>0.05
12.96
13.21
6.70
2.61
>0.05
0.62
0.77
0.96
3.26
<0.05*
3.37
1.68
1.73
0.52
>0.05
1.30
2.63
1.93
2.50
>0.05
0.83
0.74
0.96
6.69
<0.05*
1.75
1.40
1.08
0.30
>0.05
35.23
40.02
17.98
0.12
>0.05
18.57
54.18
20.23
1.72
>0.05
*P<0.05.
72
M Uyangk et al.
Discussion
The results of the present study indicated that vestibular
stimulation in addition to sensory integrative therapy and
neurodevelopmental therapy was much more effective than
the sensory integrative therapy alone.
Children with Down syndrome have muscular hypotonia,
joint hypermobility and loss of balance.2426 Connoly and
Michael examined the effects of hypotonicity on balance,
nding that the hypotonus, pelvic stability and pes planus
affect ability to balance.24 In the present study the mean
times of subjects ability to balance on one leg were found
to be low, at 7.73~0.87 s with eyes open, and 2.22~0.34 s
with eyes closed.24 In the present study subjects in all three
groups obtained low scores on the posture imitation test
which was used to assess praxis. In accordance with
previous studies, the results of study showed that children
with Down syndrome have motor planning impairment.
Children with Down syndrome suffer from loss of visual
motor control laterality, loss of balance and slow running
speed.3,27,28 In the present study, children in all three groups
obtained low scores on the DC test which was used to assess
visual motor co-ordination and visual perception. The mean
scores obtained were 3.22~0.60 out of a possible total of
26 points. The results of the present study support the results
of previous studies.
Studies in the published literature have shown that
different therapy programs have been used to facilitate
mental and motor developments. Sensory integrative therapy,
perceptualmotor training, neurodevelopmental therapy, vestibular stimulation and play therapy have been used either as
sole treatment programs or as combined programs according
to the necessity of the children with motor problems.4,15,2931
Although there was a signicant difference in DC and
posture imitation tests, in the rst group who received
sensory integrative therapy alone there was not any
difference in locomotor skills and balance (P>0.05). In the
second group who received sensory integration and
Down syndrome
Assessment of physical and cognitive features, improving
sensoryperceptualmotor dysfunction, developing balance,
improving ne and gross motor functions are important in
children with Down syndrome, because they can increase
independence in activities of daily living.
The results of the present study showed that sensory
integration, vestibular stimulation and neurodevelopmental
therapy were effective in children with Down syndrome.
Therefore, it was concluded that when designing rehabilitation
programs for children with Down syndrome, all treatment
methods should be applied in combination, and should support
each other according to the individual needs of the child.
Acknowledgments
The authors would like to acknowledge the contributions of
Prof. Meral Topu, MD and Prof. Ergl Tunbilek, MD, at
Hacettepe University, Turkey.
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