Lecture 4 (Hypotonia & DS)

Where in the nervous system does hypotonia impact?

• Anywhere, But Typically CNS

What are classic signs of hypotonia for newborns?

• No FLX Tone → Adaptive “EXT” Tone

What are classic signs of hypotonia for younger children?

• “Frog Leg” Hip ABD

• Poor Gravity Hold

What are classic signs of hypotonia for older children?

• “Hanging” On Ligaments

• Excess Lordosis / Kyphosis

How do infants with hypotonia tend to have their scapulae positioned?

• ELEV + ADD + DR + ANT TILT

What is the preferred sitting position for those with hypotonia?

• “W Position” + FLX Against Gravity

What is the life expectancy for Down Syndrome?

• What are each of the three types?

• Generally: 60 Years Old

  • 95% - Trisomy 21

  • 3% - Translocation

  • 2% - Mosaic

What are typical neurological deficits in DS?

• Nearly All: Cognitive Disability (Mild-Mod)

• Nearly All: GM & Language Skills Are Impaired

• 50% Will Eventually Develop Alzheimer’s

• 30% Have Concurrent Depression

• 10% Have Concurrent Autism

• 7% Incidence Of Seizures

How is the cardiopulmonary system impacted in DS?

• 50% Have Congenital Heart Defects

• Many Develop Sleep Apnea

How is the endocrine system impacted in DS?

• 30x More Likely To Develop Hypothyroidism

• 4x More Likely To Have Diabetes Mellitus I

What are the main two multisystem impacts of DS?

• 15x More Likely To Get Leukemia

• 6x More Likely To Get JIA

What are the two assessment tools more specific to DS?

• Gross Motor Function Measure (GMFM)

• Observational Gait Analysis for DS (OGA-DS)

What time frame is Massage recommended for DS?

• What level of evidence is this associated with?

• Massage < 10 Months

  • High Level Evidence - For DS

  • Mid Level Evidence - For Hypotonia

What time frame is Tummy Time recommended for DS?

• What level of evidence is this associated with?

• Tummy Time < 1 Year

  • High Level Evidence

What time frame is Active Motor Therapy recommended for DS?

• What level of evidence is this associated with?

• Active Motor Therapy Any Time

  • Expert Opinion Only

What time frame is Postural Management recommended for DS?

• What level of evidence is this associated with?

• Postural Management > 3 Months

  • Expert Opinion Only

What time frame is Compression recommended for DS?

• What level of evidence is this associated with?

• Compression > 6 Months

  • Expert Opinion Only

What time frame are ADEs recommended for DS?

• What level of evidence is this associated with?

• ADEs > 10 Months

  • Expert Opinion

  • Mid Level Evidence

What time frame is Power Mobility recommended for DS?

• What level of evidence is this associated with?

• Power Mobility > 10 Months

  • Expert Opinion Only

What time frame are Orthotics recommended for DS?

• What level of evidence is this associated with?

• Orthotics > 10 Months

  • High Level Evidence - For Foot Alignment

  • Mid Level Evidence - To Improve Gait

  • Low Level Evidence - For Pre-Gait

What time frame is Treadmill recommended for DS?

• What level of evidence is this associated with?

• Treadmill > 10 Months

  • High Level Evidence - For DS

  • Mid Level Evidence - For Hypotonia

What time frame is Hip Surveillance recommended for DS?

• What level of evidence is this associated with?

• Hip Surveillance > 1 Year

  • Expert Opinion Only

What is the initial frequency for infant massage?

• 5-10 min / 1 session / day

What is the “massage +” protocol?

• 30 Seconds - Talk To Baby

• 10 Minutes - Talking & Massage

  • Head → Chest → Belly

    • → UEs → LEs → Back

• 5 Minutes - Talking & Rocking

What is the initial frequency for tummy time?

• 2-3 min / 2-3 sessions / day

What is the initial frequency for use of standers?

• 60-90 min / 1 session / 5 days / week

What is the initial frequency for use of treadmill (younger children)?

• 8 min / 1 session / 5 days / week

What is the initial frequency for use of treadmill (younger children)?

• 20-30 min / 1 session / 5 days / week

What is Active Motor Therapy?

• “Activities encouraging movement that are child-active, initiated & directed.”

What is Power Mobility?

• “Anything to get child exploring environment, commonly adaptive bikes.”

What is Hip Surveillance?

• “Monitoring for any early indicators of hip displacement.”

How will supported seating devices vary in position over time?

• 3-6 Months: Tilted Support

• 6+ Months: Upright Support

How often should children wear adaptive equipment?

• 50% Of Awake Time

What is the primary non-motor benefit of early motor exploration?

• Promotion Of Cognitive Development