Intervensi terapi motorik dan

oromotor pada anak down

syndrome
dr. Teffy Aulia Merry Dame Sp.KFR
Down Syndrome?
• Trisomy 21
• Causes  not identified
• Not caused by something the
mother does during pregnancy
• Risk increases significantly with
the mother’s increasing age.
• Age 35 : 1 in 400 birth
• Age 40 : 1 in 110
• Age 45: 1 in 35
Clinical Practice Guideline: Report of the Recommendations. Down
Syndrome, Assessment and Intervention for Young Children (Age 0-
3 Years). 5½" x 8½", 292 pages. Publication No. 4958.
 Physical characteristics
• Diminished rate of growth and physical
development
• Microcephaly
• Upslanting palpebral fissures and epicanthal folds
• Small or overfolded ears, a flat nasal bridge, and
a small mouth with low oral muscle tone and a
protruding tongue
• Short, broad hands with short fingers
• Single palmar crease
• Decreased muscle tone

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Developmental characteristics
• Delayed cognitive development
• Delayed and atypical speech and
language development
• Delayed development of social
skills
• Delayed motor skills
• Possible coexistence of other
developmental disorders, mental
health or behavioral conditions
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Assesment
• Developmental level
• Physiological problem
• Status Kesehatan
• Masalah pendengaran
• Masalah penglihatan
• Cognitive skills
• Communication Social skills
• Motor skills
• Adaptive/self-help skills
• Behavior and temperament
• Gross motor  begin by 3 months of age
• Fine motor skills begin by 6 months of age
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Developmental
milestone

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Cognitive delays
(remembering steps,
problem solving)

Attentional
difficulties (ability to
focus on learning and
completing tasks)

Delayed self
help
development
Motor planning
Deficits in body
deficits (planning the
awareness
movements needed
(awareness of
to complete an
position of body
unfamiliar motor
parts)
task)

Delays in motor skill

development
(postural stability,
fine motor dexterity)

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome,

Assessment and Intervention for Young Children (Age 0-3 Years). 5½" x 8½", 292
pages. Publication No. 4958.
 Interventions
Cognitive development
Parental involved
Communication
Every 6-12 months development

Motor development
Intervention Tailormade

Social development
Early identification for
proper intervention
Adaptive/self-help skills

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Cognition
remember, think, act, feel emotions, and experience the environment

Cognitive Target
global and specific cognitive skills
intervention
Include a multimodal, multimethod approach to cognitive development

Multiple settings Multiple modalities Multiple opportunities

Basic principles
of learning
theories

Positive Observation
Association Time Often Repetition reinforcing basic drives and imitation
stimuli

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 12 to 24 24 to 36
Age birth to 4 months months
4 to12 months
months
Intervention
focused on Introduced to Interaction in
Cognitive Move an object Pull toy or object
group
learning
structured and
semistructured
experiences. activities.
development
program Saying the child’s
name often and Partially hiding a Provide
telling label for toy opportunities
things in view

Reading and
singing to the Hiding a toy
child regularly

Showing pictures
with much color
or contrast

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Focus

• Stimulation of vocalization
• Receptive and expressive language stimulation

Interventions •
•
Education on warning signs for hearing loss
Presence of hypotonia

Focused on
• Speech-motor problems  delay in communication skills, feeding difficulties

Communicatio To facilitate development of expressive language

• Sign language
n Development • Oral communication
• Visual cues

Consider

• The cognitive level

• the gross and fine motor skills
• the preferences of the family

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
Intervention • Tracking auditory stimulation
Birth to 4 • Orienting to voices
focused on months
communicati • Vocalizing when spoken to
on • Encouragement of babbling
4 to 12
development months, • Informal gestures to communicate
program include: • Direct intervention with child and parents

• Promote understanding basic concepts

Target • Following a one-step request
• Increasing vocabulary
12 expressive
• Increasing receptive and to 24 • Pointing to body parts or objects upon
language skills months request
• Improving motor speech production • Saying or signing two-word phrases
• Signing or naming familiar object
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Birth to 4 months

• Development of postural control

Muscle
tone 4 to 12 months, motor interventions include
Early
therapy • Development of postural control for prone position
• Development of the ability to move against gravity
• Development of trunk and head control for proper alignment in sitting
• Development of transitional movements
• Fine motor interventions  6 months old.
Adaptive
equipment
12 to 24 months

• Fine motor skills be continued

• Improving the use of muscular control, posture, and movement
• Balance and coordination of trunk muscles
• Use of varied movements for transition

After age 24 months

Interventions Focused on • Intervention for development of fine motor skills be continued
Motor Development program • Development of independent walking
• Appropriate adaptive equipment
• Development of stair climbing
• Development of higher level motor skills
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Focus on social attention, social interactions, attachment, and
play.

A major component  helping parents to interact with a

children
Interventions
Focused on Social
Development Multiple settings

Encourage them to interact  facilitate play skills and

enhance social skills.

More responsive to instructions that are directive (specific)

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Interventions
Focused on Often the most
Adaptive/Self-
important for families.
Help Skills More
independently.
Referred to as activities of daily living, include
dressing/grooming, feeding, and toileting
Depend on the child’s
cognitive and motor skills
Children with down syndrome may need more repetition in
learning selfcare tasks than typically developing children
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
 Feeding
Motor based
problem

Sensory
Environmental perception
based cognition
Respirations based

Feeding

Vocalization Experienced
based
Structural
based
s
 Feeding strategy

• Distinct Mealtimes
• Consistency in mealtime and premealtime routines
• Provide adequate support and positioning
• Use utensils, dishes, and cups that are developmentally appropriate

Dressing strategy

• Encourage children
• Appropriate for the child’s motor and cognitive abilities
• Provide adequate support and positioning
• Making simple modifications

Toilet training strategy

• Motor and cognitive skills  important component of successful toilet training

• Familiarization
• Appropriate size and configuration

Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
Major concepts

Individualized Identificatio
n
Reinforcing stimuli

Consistent reinforcing stimuli

Introduced sequentially
Repetition Education
Waiting and providing positive reinforcement

Visual teaching methods

Intervention
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years).
5½" x 8½", 292 pages. Publication No. 4958.
Thank you