What is Down Syndrome?

According to the National Down Syndrome Society (NDSS) (http://www.ndss.org/) Down Syndrome occurs when an individual has a full or partial extra copy of chromosome 21. This additional genetic material alters the course of development and causes the characteristics associated with Down Syndrome.

Children with Down Syndrome have various physical traits that are associated with the diagnosis. Some of these traits include: lower muscle tone (hypotonia), loose joints, increased flexibility, short height, and smaller heads.

How is the Hypotonia Wheel structured?

The hypotonia wheel is considered a “wheel” because it is a continuous and dynamic process. On the outer ring of the wheel are the 4 cornerstones. These cornerstones are where the Physical Therapist establishes the family centered goals for the child, recognizes any environmental barriers, makes sure that every child is having fun and actively involved, and that the family is included in the treatment! These 4 cornerstones are crucial to the creation of a quality physical therapy treatment session for the family.

The middle ring consists of 6 information bullets. These information bullets construct the intervention guidelines that Physical Therapists can use to encourage creative activities that are both fun and functional. These intervention guidelines include encouraging movement against gravity, using age appropriate solutions, consider any positioning devices, encourage age appropriate positions, use functional positions, motivate the child, continue to be patients, and provide plenty of opportunities to practice during treatment and at home with parents.

The inner ring consists of 10 questions based on motor skill development. Examples of these questions include: Does the child have head control? Do they walk alone? Are they independently getting into/out of sitting? Do they sit alone? Are the moving to explore? If any of these questions lead to “no” the user of the Hypotonia wheel is prompted to ideas that could make this motor skill easier for a child. A full example of this would look like “Does the child sit alone” and if the answer is “no” one of the suggestions is for the therapist to look at the base of support and child’s posture in sitting.

 This Hypotonia Wheel is a great resource for Physical Therapists to reference while creating functional treatment sessions for children with hypotonia. It is important for Physical Therapists to keep in mind safe positioning of these children and consider any adaptive equipment that may be necessary.

What is the Hypotonia Wheel?

Hypotonia, by definition, means that there is too little tension in a muscle. Children and adults with hypotonia appear to be more flexible and their muscles look like they are fully relaxed.  Hypotonia is one of the main physical traits that is present in children with Down Syndrome. Children with hypotonia often experience delayed motor skills, decreased active muscle control, they sit in a “W” base of support, they have increased range of motion in most of their joints, and they have flat feet.

The Hypotonia Wheel (Hypotonia wheel and guide: Clinical recommendations for infants and young children with hypotonia published by Sunny Health Centre for Children) was created as a guide for Physical Therapists to bring out creative and safe ways to provide treatment for children with hypotonia.

The treatment ideas from the Hypotonia wheel:

  • Activity-focused functional skills: like practicing to ride a bike (with or without training wheels), self-feeding, hygiene, and sports.
  • Postural strengthening
  • Encouraging movement while decreasing base of support. This will improve a child’s balance and encourage exploring their environment.