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This case study focuses on the ongoing physical therapy management of Carrie, a child with Down syndrome. Carrie has received physical therapy services from the age of 4 weeks to the present. For individuals with Down syndrome, episodes of physical therapy services may be necessary across the life span to address changing issues as growth occurs and as the child gains increasing independence in various environments. Functional demands change as the individual moves from infancy, through the school years, and into adulthood.

Individuals with Down syndrome commonly present with impairments in strength (Stemmons-Mercer & Lewis, 2001), range of motion (ROM) (Zausmer & Shea, 1984), tone (Shea, 1991), balance and coordination (Connolly & Michael, 1986; Lauteslanger, Vermeer, & Helders, 1998), and sensory processing (Uyanik, Bumin, & Kayihan, 2003) leading to delays in acquisition of motor skills and to functional limitations. Associated impairments, such as mental retardation (Hayes & Batshaw, 1993; Henderson, Morris, & Ray, 1981), cardiovascular pathology (Freeman et al., 1998), and frequent middle ear infections, may also have a negative impact on motor skill acquisition and activities.

The impairments of body structure and function and limitations in activities and participation presented by Carrie led the health-care team to consider the physical therapy management options described in Preferred Practice Patterns 5B: Impaired Neuromotor Development and 4C: Impaired Muscle Performance as outlined in the American Physical Therapy Association (APTA)'s Guide to physical therapist practice (APTA, 2001). Ultimately, Pattern 5B: Impaired Neuromotor Development was selected because of Carrie's delayed motor skill development, impaired cognition, and sensory integration impairments. This case study will focus on episodes of care at 3 years and 16 years of age, with a brief review of Carrie's transition into adulthood. Physical therapy services at ages 3 and 16 were provided by therapists working in educational settings in accordance with the federal legislation Individuals with Disabilities Education Act (IDEA) (2004).

Examination: Age 3 Years


At Carrie's birth in the late 1970s, doctors were suspicious of a potential diagnosis of Down syndrome. She presented with soft signs, including slanted eyes, poor sucking reflex, and hypotonia (Fig. 21.1). When Carrie was 2 days old, she was transferred from her local rural hospital to a major urban hospital for genetic testing. At this time, a diagnosis of Down syndrome was confirmed. Her parents, Tim and Peggy, were both 35 years old and had three other children: Wendy, 12 years; Jamie, 9 years; and Thea, 4 years. Tim and Peggy's initial reactions were love for Carrie, fear of the unknown, and uncertainty of their capabilities as parents of a child with special needs. However, they were determined to help Carrie in every way they could.

Figure 21.1

Carrie at birth.

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