Physiotherapy Rehabilitation for Down Syndrome

In every cell in the human body there is a nucleus, where genetic material is stored in genes.  Genes carry the codes responsible for all of our inherited traits and are grouped along rod-like structures called chromosomes.  Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. 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. A few of the common physical traits of Down syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm - although each person with Down syndrome is a unique individual and may possess these characteristics to different degrees, or not at all.

Approximately one in every 700 babies in the United States is born with Down syndrome, making Down syndrome the most common chromosomal  condition. About 6,000 babies with Down syndrome are born in the United States each year. 

 

TYPES :

1.TRISOMY 21 (NONDISJUNCTION)

Down syndrome is usually caused by an error in cell division called "nondisjunction."  Nondisjunction results in an embryo with three copies of chromosome 21 instead of the usual two.  Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate.  As the embryo develops, the extra chromosome is replicated in every cell of the body.  This type of Down syndrome, which accounts for 95% of cases, is called trisomy 21. 

2.MOSAICISM 

Mosaicism (or mosaic Down syndrome) is diagnosed when there is a mixture of two types of cells, some containing the usual 46 chromosomes and some containing 47.  Those cells with 47 chromosomes contain an extra chromosome 21. 

Mosaicism is the least common form of Down syndrome and accounts for only about 1% of all cases of Down syndrome.  Research has indicated that individuals with mosaic Down syndrome may have fewer characteristics of Down syndrome than those with other types of Down syndrome.  However, broad generalizations are not possible due to the wide range of abilities people with Down syndrome possess. 

3.TRANSLOCATION 

In translocation, which accounts for about 4% of cases of Down syndrome, the total number of chromosomes in the cells remains 46; however, an additional full or partial copy of chromosome 21 attaches to another chromosome, usually chromosome 14. The presence of the extra full or partial chromosome 21 causes the characteristics of Down syndrome.

Body shape and size

• Short stature (height). A child often grows slowly and is shorter than average as an adult.
• Low muscle tone (hypotonia) throughout the body. Belly muscles with low muscle tone can make the stomach stick out.
• A short, wide neck. The neck may have excess fat and skin.
• Short, stocky arms and legs. Some children also have a wide space between the big toe and second toe.

  Face shape and features

• Slanted eyes. The doctor may also notice small spots on the colored part of the eye

• A nasal bridge that looks pushed in. The nasal bridge is the flat area between the nose and eyes.
• Small ears. And they may be set low on the head.
• Irregularly shaped mouth and tongue. The child's tongue may partly stick out. The roof of the mouth (palate) may be narrow and high with a downward curve.
• Irregular and crooked teeth. teeth often come in late and not in the same order that other children's teeth come in.

Health problems

Some health problems related to Down syndrome are:
• Intellectual disability. Most children with Down syndrome have mild to moderate cognitive disability.
• Heart problems. About half of the children who have Down syndrome are born with a heart defect.
• Hypothyroidism, celiac disease, and eye conditions.
• Respiratory infections, constipation, hearing problems, or dental problems.
• Depression or behavior problems associated with ADHD or autism. 
• Rehabilitation:
  
  

  

  
  
  
  

  There is no single, standard treatment for Down syndrome. Treatments are based on each individual's physical and intellectual needs as well as his or her personal strengths and limitations. People with Down syndrome can receive proper care while living at home and in the community.
  
  A child with Down syndrome likely will receive care from a team of health professionals, including, but not limited to, physicians, special educators, physical therapists, speech therapists, occupational therapists, , and social workers. All professionals who interact with children with Down syndrome should provide stimulation and encouragement.
  
  we are doing upcoming therapies to Rehabilitate Down Syndrome kids.
  
  Physiotherapy includes activities and exercises that help build motor skills, increase muscle strength, and improve posture and balance.
  
  Physiotherapy is important, especially early in a child's life, because physical abilities lay the foundation for other skills. The ability to turn over, crawl, and reach helps infants learn about the world around them and how to interact with it.
  A physical therapist also can help a child with Down syndrome compensate for physical challenges, such as low muscle tone, in ways that avoid long-term problems. For example, a physical therapist might help a child establish an efficient walking pattern, rather than one that might lead to foot pain.
  
  Speech-language therapy can help children with Down syndrome improve their communication skills and use language more effectively.
  
  Occupational therapy helps find ways to adjust everyday tasks and conditions to match a person's needs and abilities.
  
  Emotional and behavioral therapies work to find useful responses to both desirable and undesirable behaviors. Children with Down syndrome may become frustrated because of difficulty communicating, may develop compulsive behaviors, and may have Attention Deficit Hyperactivity Disorder and other mental health issues. These types of therapists try to understand why a child is acting out, create ways and strategies for avoiding or preventing these situations from occurring, and teach better or more positive ways to respond to situations.

Shin Splints and its Physiotherapy Management

Definition:

 The pain known as shin splints, generally starts with a tight and painful feeling along the side of your shin bone (tibia). This is classed as MTSS, as the tibia bone is being stressed through dysfunction of the surrounding muscles. If these muscles continue to work in a dysfunctional way, they create more and more stress through certain points of the bone and this can then develop into a stress fracture of the bone.

Causes:

There are many risk factors to the development of tibial stress, some of which can be helped and others that can’t. These are known as intrinsic (things inside your body – some that you can’t change) and extrinsic (external things you can change) risk factors, as you will see below:

Intrinsic factors:

• Poor conditioning and high BMI (Body mass index)
• Previous MTSS or lower leg injury
• Lack of running experience and competitive running
• Female
• Increase in navicular drop (bone stability in your foot)
• Increased hip external rotation in males

Extrinsic factors:

• Type of sport
• Training frequency
• Shoes and orthotics
• Hard and uneven training surfaces

Prevention:

For those factors that can be changed, there are a few things you can do to help prevent shin pain, or at least avoid making it worse.

First there is the training frequency and load. For a high performance athlete this will be huge, but most of us can’t go straight to that level! It is important to start at level that is achievable for you. This is especially important if you have never been a runner or you have never played a particular type of sport before. The same goes for the type of surface you are running on. If you are on grass for every run until one day you decide you are only going to run on concrete, your body can’t adapt to the change fast enough, and hence you start to get dysfunction in the muscle and stress points.

The type of shoe you wear is also important, as you need to have the correct stability and flexibility for the type of activity you want to do.

Obviously some of the intrinsic factors can be changed too. However these factors are something you have no matter how fast or slow you start out and therefore you need to be extra careful if you have them. For instance, if your BMI is higher there is an increased risk of MTSS and stress fracture. This seems ironic in the fact that you need to do exercise to decrease your BMI, but it is as we have mentioned above…you need to start at a level that is achievable for you and your body. 

Now if you do have “shin splints” then the first thing to do is REST! I know you don’t want to hear that, but I actually mean relative rest from the intensity and frequency of training that you are currently at. For example if you think about a scab from a cut – if you continue to pick at it and pick at it when it is only half healed, the whole healing process has to start again and you are back to square one. It is the same with injuries on the inside, if you have MTSS and you keep stressing those muscles, they will not heal and you may develop a stress fracture.

It is best to see a physio as fast as possible, to help you get back on track as quickly as you can and set up your activity plan. They will help you build your training up specifically for you and your body, help prevent stress fractures and most importantly get you back to your best!

Treatment for Shin Splints

1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection.

In the early phase you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your physiotherapist will advise you on what they feel is best for you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. As you improve a kinesio style supportive taping will help to support the injured soft tissue and provide some stress reduction for your shin bone.

Anti-inflammatory medication (if tolerated) and natural substances e.g arnica may help reduce your pain and swelling. 

2: Regain Full Range of Motion 

If you protect your injured shin muscles while they heal and strengthen. This may take several weeks. During this time period you should be aiming to optimally remold your scar tissue to prevent a poorly formed scar that will re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neuro-dynamic mobilizations and specific exercises. Your physiotherapist will guide you.

3: Normalize Foot Bio mechanics

Shin splints commonly occur from poor foot bio mechanics e.g flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilization program. 

4: Restore Muscle Strength

Your calf and shin muscles will need to strengthened to enable a safe resumption of sport or training.

5: Modified Training Program & Return to Sport

Most shin splints occur due to excessive training loads. Running sports place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with training schedules and exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance. 

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your  physiotherapist will discuss your goals, time frames and training schedules with you to optimize you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimized your chance of future injury.

Prognosis:

There is no specific time frame for when to progress from each stage to the next. Your shin splints rehabilitation status will be determined by many factors during your physiotherapist's clinical assessment. You'll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. The severity of your shin splints, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Outdoor Exercises benefits in the winter

Outdoor exercises will help your good circulation, maintaining body temperature, help to overcome from the winter. You will get lot benefits, while getting out of your room to the outdoor for your daily routine exercises.  The weather's getting colder and sometimes it’s hard to fight the urge to rug up in front of the tv with a mug of hot chocolate. Sure, there’s nothing wrong with having a little downtime once in a while, but it’s important you don’t let the cold weather stop you from getting your dose of daily exercise. you will enjoy your daily exercises if you read this post fully. 

I will guide you some of good beneficial activities in the winter, If you are anyone like me, the thought of stepping into a sweaty gym isn’t exactly at the top of your list of favourite things to do. I prefer to get my exercise the old fashioned (and non-expensive) way – walking. 

In my knowledge , there is a lot specific exercises and how they made, to maintain the good circulation as well as body temperature. These same points apply if you're a runner or enjoy doing any sort of outdoor exercise:

Wear suitable clothing: Be aware of the weather conditions (including wind chill factor) and dress appropriately. Choose fabrics that will keep moisture away from your skin to stop you from getting wet and cold. Wearing lots of layers is also a good idea as you can discard them as you get warmer. And of course, brightly colored clothing is a must for walkers and joggers for visibility. As one-third of your body heat escapes from your head, remember to grab a hat (as well as gloves) before you head out the door. So wear your clothes accordingly.

Safety first: Dare out in daylight as much as you can and be careful to avoid muddy, slippery surfaces. If you must head out at night, take a torch and wear reflective gear. These are the things helps you to take care of yourselves.

Drink lots of water: Even though it's not as muggy, keeping your fluids up is as important in winter as it is in summer. So try to consume a lot of water

Warming-up: If you are a jogger, set some extra time aside for your warm-up exercises. This is really important for warming up tight muscles in order to prevent injuries. And always remember that it's not a good idea to run when you have a flu or a cold, as it puts extra stress on your heart. So keep in mind all of these while you venture out of the doors.

keeping your daily exercise routine outdoors this winter, check out these added benefits:

According to most of recent studies, moderate exercise can boost your immune system and help fight off bacterial and viral infections. When your blood gets pumping, immune calls travel through your body at a faster pace which helps them to seek and destroy infections.

You will burn more calories too, because your body is working harder to keep warm. As your metabolism gets cranking your body will burn more calories and fat to produce more energy.

It will boost your mood! If you’re someone who feels a bit blue when it’s all dark and chilly outside, exercise endorphins really help to pick you up and lift your mood. It will give more positive energy.  Also, you’ll get the benefit of increasing the production of mood-elevating Vitamin D.

And finally, it’s great for your will-power. After a couple of days of biting the bullet and heading outdoors, it will become easier to ignore the cosines of the couch and instead burst outside with great  on a regular basis.

Don’t let the cold keep you inside this winter! Throw on a couple of extra layers, get outside and get moving – your body and your mood will thank you for it. So keep those things , while venture out from your doors. You will get get those benefits.

We need Physiotherapist Advises for Exercises?

There are simple exercises you can safely do for a range of problems often relating to a injury of some kind.  You should consult your physiotherapist or medical practitioner. Because you don't know about your muscle power, what kind of injury is inside? you don't know the bio mechanics, So please consult your physiotherapists for their guidance. 

How can do?

It is very important to do the exercises well if you are to get the benefit and improve your condition.

Do them regularly if you are going to do them at all. The tissues of the body respond to regular, repeated stresses to change how they behave. To achieve this you will need to repeat the exercises a certain amount of times every single day. it will be beneficial.

Do each exercise individually. If you try and do two movements at once, neither movement will be done well or to the maximum degree. This cuts down the effectiveness and may stress your joints more than you intend.

Go to the end of each movement. There’s no point waving a joint around in the air as joints usually have problems at the end of their available movement at the time. Make sure you move each joint to the end of the movement if you can.

Do the movement slowly and steadily. Jerking or moving quickly can be painful and strain something, as well as not permitting the part to relax as the movement progresses.

Pay attention to pain. This is a difficult one. Pain can mean that the painful area is damaged and you should not move it until it has healed more, but it can also be much less important. If your joint is stiff, you will need to stretch it and cause some pain if it is to loosen up.Good pain is not too severe and settles down quickly. Bad pain is severe and takes a long time to settle down after. If you cause pain on exercise, and you may have to to succeed, make sure it is good pain.

Make specific times to exercise through the day as this makes it more likely you will actually do them.

How many repetition?

Difficult question again. This depends on the type of condition you are suffering from.

Stiffness and no pain. Physiotherapists classify this kind of problem as non-irritable, meaning the problem can cope with a lot of physical stress, producing little pain which settles quickly to normal. You can push this kind of condition fairly hard and often, such as 10 movements/stretches every two hours (if necessary), going right to the end of the movement.

Stiffness and pain. Here more care is needed, as the joint may be irritable so that exercise stirs up the pain. A good rule is: if the exercise does not cause significant pain for a significant period of time, then you have it about right. You will be likely to feel some pain as you do the exercise and this is to be expected.

Pain. Significant pain can stop you wanting to move your joints and muscles, causing weakness and loss of movement. Appropriate movement can help pain, range of movement and muscle power.Here we need to be careful to strike a balance between putting enough stress on the joints and muscles and increasing the pain. A few movements a day may be enough for a very irritable joint.

When you have done your exercises, how was it? If your pain is bad and lasts over 10 minutes or so you may have overdone it. If you have some discomfort but it is bearable and goes off quickly that may be the right level of input.

If you have no sense of strain or stretch at all when doing your exercises you may be doing nothing at all. You should be able to adjust the level of your exercises depending on how your pain or stiffness problem behaves. If in doubt get the opinion of a physiotherapist or other manual therapist.

So these are the things , you need advises from the physiotherapist, while attempting new or therapeutic exercises.