TRISOMY 21: DOWN SYNDROME

CASE STUDY

Neurodevelopmental Progress for Male Child with Down Syndrome,

SITUATION
Male child MH aged six years and five months. M has Down Syndrome, nystagmus, myopia and had severe digestive issues with pica at the time of the assessment. He is the elder of two children. His sister is two years and nine months and was adopted nine months ago. He lives at home with both parents and is attending mainstream school with support.

Clinical History
 Pregnancy

The pregnancy was extremely difficult. His mother had hyperemesis throughout the entire pregnancy. She was hospitalized for the first three months and placed on drips to maintain hydration levels, She was on medication (Stemetil and Promethazine) throughout. She had no net weight gain during the pregnancy. initially there was weight loss. At the end of the pregnancy she was the same weight as at start.

 Birth

M was distressed last 2-3 days of pregnancy due to strangulation of umbilical cord. He was born eventually by emergency C-section under general anaesthetic as the spinal block did not work fast enough. His APGAR scores were 1 and 3. He was resuscitated for 30 minutes to establish breathing and heartbeat. He was on ICU for nine days and further three days in hospital.

 Health

M was generally healthy. He had one ear infection requiring antibiotics. He underwent surgery for undescended testicle at 18 months. From birth his bowel movements were regular and once day until a stomach bug at age four and a half. Since then he has had diarrhea and loose stools with a complete loss of bladder and bowel control. He wears diapers and opens his bowels 5-15 times per day.

 Nutrition

M eats a well-balanced diet with lots of vegetables and very little dairy as he is prone to congestion. Takes Omega oils and a children s multivitamin.
 Treatments

He has had acupuncture, speech therapy, audiology input and has seen an eye specialist.

 Schooling

M is behind his classmates academically and behind his peers who have Down Syndrome. He had been concentrating quite well in nursery but has fallen Further behind since he contracted the stomach virus in his first weeks of school.  Referral to HANDLE His mother had noticed changes in a client of hers who was on a HANDLE program and wanted to see how it could help her son

 Referral Concerns  To improve expressive language and clarity of speech  To be able to regulate/modulate his strength.  To follow rules and instructions better.  To improve concentration in the classroom.  To cope with transitions more easily.  To go to sleep more easily, reduce sleepwalking and to stay asleep.  To regain bladder and bowel control

Findings
Assessment Date: November 25, 2008 Age at assessment: six years and three weeks M. eats anything that he can get into his mouth including feces. He has a reduced sense of smell. He is very tactile sensitive around his face and hates having his face washed. He has difficulties with balance and is constantly on the move. He is a very poor sleeper and sleepwalks up to eight times per night. He has very low muscle tone and tires easily. M. has difficulty with expressive language and articulation and augments this with sign language. When assessed he had chronic diarrhea and no bladder or bowel control. He dribbled a lot. He has difficulty sustaining visual focus and nystagmus. He had not yet begun to read or write.

INITIAL PROGRAM
 Crazy Straw and blowing activities to help with sphincter       

muscle control for bladder and bowel control and to aid digestion. Face Tapping to reduce tactile sensitivity and to support muscle tone and articulation. Vestibular activities to help strengthen his vestibular system. Hug and Tug to improve fine motor control, improve speech and Interhemispheric Integration. Two-Finger Spinal Massage to help reduce stress Peacemaker Massage to improve proprioception and aid sleep. Back Thumping to help keep chest clear and aid vocalization. Accentuation Tap to help with language development and to enhance interhemispheric integration.

Review January 16, 2009

go regularly and has 1-2 well formed stools a day.  He had an acupuncture treatment to address intestinal pathogens after his first HANDLE session.  His articulation is improving slightly and the amount of dribbling has also reduced.  His mother reports that all the family were unwell over Christmas and that his sister has been unsettled recently. This has meant that only Crazy Straw and blowing activities have been performed regularly.

 Since November the only change in terms of

treatments has been the addition of HANDLE activities.  M has been reluctant to do a lot of the other activities and so his mother has been carrying them out on a toy dog for Mental rehearsal. She has not been able to find time to do the activities anywhere near as much as she would like. Hoop  Mazes has been added to his program to help support his proprioception and vestibular system.

Review April 1, 2009

and that he is now accepting all the HANDLE activities.  M is now requesting the toilet himself and only had one accident in the past month.  His dribbling has now stopped and he rarely makes a mess when eating. He is using a fork or spoon most of the time instead of finger feeding.  His speech is improving in terms of articulation and increased vocabulary.  He now only sleep walks once or twice a night instead of 8-10 times.

 School is delighted with the changes. He is

concentrating for much longer and can sit through assembly.  Previously M worked for 10 minutes then played for a while before returning to work. Now he wants to continue working.  He is beginning to recognize several words by sight and is writing the letter M and working towards writing his name.

 He is able to remember instructions much better

and has improved in being able to cope with transitions and is employing his own transitional strategies.  He has just begun to kick a ball and join the others playing soccer in the playground.  They did not add any new activities to his program.