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Individuals with Down syndrome commonly present with impairments in strength (Cowley et al., 2010), range of motion (ROM), tone (Caird, Wills, & Dormans, 2006), balance and coordination (Galli et al., 2009), aerobic capacity (Cowley et al., 2010), and sensory processing (Bruni, Cameron, Dua, & Noy, 2010) leading to delays in acquisition of motor skills and to functional limitations. Associated impairments, such as cognitive impairment (Rachidi & Lopes, 2008), cardiovascular pathology (Bergstrom et al., 2016), and frequent middle ear infections (Patiroglu, Cansever, & Bektas, 2018), may also have a negative impact on motor skill acquisition and activities.

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. This case study focuses on the ongoing physical therapy management of Carrie, an individual with Down syndrome. Carrie has received physical therapy services from the age of 4 weeks into adulthood. She was able to walk independently by 20 months of age, although in that distant past, she did not receive the now evidenced-based intervention of treadmill training to facilitate walking (Ulrich, Lloyd, Tiernan, Looper, & Angulo-Barroso, 2008). This case study will focus on episodes of care at 3 years and 16 years, and will include updates of her adult life. 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 Improvement Act (IDEA) (2004).

Examination: Age 3 Years


At Carrie’s birth in the late 1970s, doctors suspected a diagnosis of Down syndrome as Carrie presented with soft signs, including slanted eyes, poor sucking reflex, and hypotonia (Fig. 20.1). When Carrie was 2 days old, she was transferred from her local rural hospital to a major urban hospital for genetic testing, which confirmed a diagnosis of Down syndrome. Her parents, Tim and Peggy, 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 disabilities. They were determined to help Carrie in every way they could.

When Carrie was 4 weeks old, her family began the process of early intervention (EI) to foster Carrie’s development. The EI services team included an educator, speech therapist, and physical therapist. Carrie received weekly home visits from the physical therapist to assist with facilitating her gross ...

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