Down Syndrome (DS), which occurs in 1 out of every 691 live births, is the most common genetic disorder in the United States. It is characterized by multiple physical and cognitive impairments that impact development and typically persist into adulthood. Due to the prevalence of musculoskeletal impairments such as ligamentous laxity, hypotonia, and abnormal bony alignment in the foot, medical providers frequently prescribe foot or ankle orthoses for children with DS. The International Classification of Functioning, Disability, and Health (ICF) provides a unique framework to clarify the impact of orthotic intervention on three domains of human function: body structure and function, activity, and participation. Research indicates that orthotic intervention addresses body structure and function by decreasing excessive calcaneal eversion and pronation, as well as enhancing the development of the medial longitudinal arch. By optimizing skeletal alignment and lower extremity loading mechanics, orthoses may minimize abnormal tissue stresses and play a role in preventing future injury and mobility impairments. In addition, research indicates that orthoses positively impact the activity domain of the ICF, improving balance, gait parameters, and gross motor skills such as running, jumping and navigating stairs. This has implications for the development of complex movement strategies, energy efficiency and mobility within the community. Unfortunately, there is little research looking specifically at the effect of orthoses on participation. This domain is of particular interest considering children with DS typically demonstrate decreased involvement in self and family care tasks, have fewer friends, and participate in fewer sports and hobbies than typically developing peers. Although current research has not established a clear link between orthoses and increased participation, there is evidence for the interdependence of the ICF model and a link between functional skill acquisition and increased participation in children with DS. Therefore, this paper theorizes that by addressing body structure and function impairments and decreasing functional limitations, orthotic intervention will also increase participation for children with DS. Further research is needed to substantiate this hypothesis and to clarify the role of orthotic intervention in children with Down Syndrome. Understanding the specific impact of orthoses at each level of the ICF will help therapists to better determine which children with DS may benefit from orthotic intervention to augment other therapy. Furthermore, the potential for orthoses to not only affect skeletal alignment and improve gross motor skills, but also increase participation, may provide parents with additional information when considering whether potential out of pocket investment in this intervention is warranted.
University of Puget Sound
Burman, Emily; Thompson, Vanessa; Finney, Monica; and Looper, Julia, "Orthotic Intervention for Children with Down Syndrome: A Review Based on the ICF Model" (2016). Physical Therapy Research Symposium. 25.