Down's Low Tone General Recommendations

DS under 5 years Home Exercise Program:

For the next month try to focus on doing more of the following to strengthen motor skills. Most of these activities are actually toys and equipment that can be purchased, so that you provide a safe place for the child to play and then they will naturally practice in their play time most of the skills they need to work on! I try to make the recommendations as "functional" or as part of a daily routine as possible as all parents of young children are too busy to do much more than 20-30 minutes of hands on 1:1 therapy a day. By setting up a home based "little therapy room" the child will naturally begin to do therapy activities on their own!

1. Vestibular input: it is best to swing at least two times daily for 15 minutes each time, try some spinning slowly, and go faster if the child doesn't get upset. This will help increase muscle tone. You can also spin gently on a snow saucer with a therapy ball placed inside it, have the child lay over the ball on their belly first and spin them gently. Make sure to do equal rotations to each side, such as 10 spins to the left, stop for 2-3 minutes let them run or jump, then do 10 spins to the right! It is a lot of fun for all the family!

Try doing games and play that includes rolling, hanging upside down (hold their feet, do somersaults) this will also help with balance and muscle tone. Jumping on a trampoline, even the small blow up plastic ones for around $20, are great indoor activities to promote jumping, rolling, catching themselves in falling, flipping, and all of this input to their vestibular system will help increase muscle tone, strength, endurance, and overall motor development. Think about doing gymnastics classes if you can't do these activities at home.

2. Proprioceptive (joints and muscles): give a lot of opportunities to continue to weight bear on hands to help build up palmer arches and strengthen web space (muscles between thumb and first finger). Some ways to do this may be to get a crawl through tunnel, cut out holes on the sides of boxes and make crawl through houses, throw down all couch pillows and extra pillows on the floor and "chase" each other creeping on hands and knees, make tents for playhouses over tables and chairs to crawl around in, use tunnels (homemade ones are fine!), old mattresses to jump and crawl on, and most of all make a safe place for practicing wheelbarrow walking, start with walking on hands off the therapy ball, and work up to walking around without support of ball underneath them. The blue Elliptical pill looking ball from Walmart in the exercise section for under $13 is great for all kinds of activities, but especially good for beginning wheelbarrow walking!

They also have a blow up incline wedge that is great for crawling up, rolling down, and flipping on in a safe space in the house! I also highly recommend that you have a higher than shoulder height basketball goal and a 2-3 pound medicine ball that is "squeezable" that she can squeeze well to hold. Medicine balls can also be purchased in the exercise section of Walmart or other sports stores for under $10. If you can't get a basketball goal, then just use a laundry basket or bucket but placing it above shoulder level height is the best option! This will help strengthen the core trunk muscles, upper body, and hand and arm strength greatly as well, and is a lot of fun for all the children!

Vibration, massagers, bumble balls are also great for low muscle tone, any kind of vibration helps stimulate tone and wakes up those muscles making them more alert and ready to move!

This way you are providing toys that naturally will stimulate balance, muscle tone, upper body strength and coordination, and core trunk strength which in turn will give them foundational skills for harder tasks such as cutting, writing, and academics!

3. Tactile play: make sure there are many opportunities for touch play in many different textures. This includes edible foods, puddings, jellos, kids shaving cream called Fun Foam, and combine texture play with fine motor work such as placing marshmallows in a bottle or sticking them to a snow picture. Texture play is often best done in the bath tub, you can use the side of the tub for the pudding, shave cream, hair gel makes great "slime", washable paints, and other textures to make circles, lines, crosses and X in these textures while in the bath tub using the side of the tub as you incline board! Another safe place in the summer or in the winter in the garage is in a small kiddie pool! Then you can use rice and sand! Homemade textures such as mixing flour and water or starch and water give some good "resistance or pull" when making shapes or letters, this helps them "feel" the movement more, making a stronger motor memory!

4. Fine motor strengthening: the key to good fine motor skills is good core muscles and trunk stability which only comes from good vestibular and proprioceptive feedback. So all of the gross motor and sensory motor tasks aforementioned, are vital to developing the groundwork and are stepping stones to good fine motor control. A child that does not like to draw or do other fine motor tasks, usually it is because they are not motor skill developmentally ready for that task, or they have a vision disorder that makes near work difficult.

Here are a few quick ideas on how to naturally help gain better fine motor control:

*put anything to color, paint, or puzzles on an incline such as on a painting or chalk easel, tape paper to a mirror, or play with removable stickers on the windows. Removable cling on decors with their favorite character on the windows and doors are always a good way to promote pincer grasp, wrist extension, and fun fine motor activity.

*Another favorite of mine now is the Leap Frog Fridge Magnets with the farm animal puzzle, and the ABC 123 magnets.

*Placing their favorite pictures of themselves and family members (including the dog and cat!) on soft pliable fridge magnets are also a great way to get the wrist extension and pincer grasp promoted in natural play setting.

*Use magnetic clips to clip up Color Wonder paper, and only have color wonder markers available so that they can color on that paper and make a mark only on that paper while sitting or standing at the fridge or dish washer, or even in the laundry room as most magnets work on washers and dryers as well!

*Play with play dough and modeling clay (more like theraputty used in therapy with a firmer texture)often, helping them to squeeze it, roll it, and pinch it. Hide small objects in the play dough for them to find by using fingertips, pinching, and pulling.

*Put snacks in a small opening cup to force more finger isolation (one finger) and fingertips to reach in and try to get them out. Put cheerios into a "fine motor can" just a simple plastic container with a hole cut out of the lid, this way they have to invert the container, pour things out, then use a pincer grasp to put them back in.

*Keep felt pipe cleaners handy in the kitchen, then place anything that has a hole in the middle of it on it for snack or mealtimes such as cheerios or other cereals. This promotes lacing and beading exercises but they work on it while you are getting meals ready!

*Make a scarf bottle, put pretty colored scarves or pieces of brightly colored materials in a tall creamer or even a coke 16 ounce bottle, cut a hole in the lid if needed, close the lid on the creamer bottle, and have them pinch and pull them out with their fingertips and thumb pinching to pull it out, they will inevitably want to then push it back in, which is another great activity.

5. Self Help skills: this takes a lot of patience and is more time consuming because you do have to help more in this area!

*Dressing: have plenty of dress up clothes in a box or laundry hamper that they can practice dressing up with easy to pull on clothes during play time. Pulling on and off little dance skirts and ballet skirts are often the best way to learn how to pull up and down your pants! For boys, animal dress up clothes can be found at Halloween as well, cowboy dress up, fireman dress up, etc.

*Shoes and socks: practice is the key, letting them practice on their own in a safe environment, because they are more than liking going to fall down trying to get them on and off, sitting them against the wall helps a lot, or in a large chair to give them the trunk support. Backward chaining is the best method, this means you do as much of the first couple of steps such as putting the socks on most of the way, then they pull up at the end to finish the task. This way they feel successful that they were the to finish the task! Then you gradually do less and less at the first steps, as they gain more skills. Putting a red dot with a permanent marker for the right shoe and a green dot for the left inside the sole of the shoe, or other techniques help them remember which one goes on which foot too to decrease the frustration.

*Zippers: play bags that have large zippers and storing toys in bags or old backpacks are great way to help them learn zippers. If the zipper is too small for them to pinch and pull, then use a binder loop used for hole punched papers found at office max or walmart in the office supply to attach a large circle metal loop onto their zippers helps this made easier until they gain the skills needed to pinch.

*Pulling up and down pants: Only wear elastic waited clothing when working on this skill! Some children need "loops" sewn into their pants, one on each side to put their wrist through and pull up and down this way, this is time consuming though and most parents don't take the time to do this. Putting their thumb inside the pants closest to their tummy and using the "web space" to push down with is the best way to teach this, rather then pinching and pulling. To pull up, the same position with only the thumb inside, but the fingers have to all grossly grasp the pants, squeezing in a gross palmer grasp to pull up.

*Tooth brushing: often a fun child's vibrating toothbrush is best, Tom's organic tooth pastes are great tasting and with fluoride free they can swallow a lot and it won't hurt them! Using a vibrating toothbrush with a spin head will also help stimulate oral muscle tone and can be given with a cup of water prior to meals to help get the oral motor muscles ready for chewing! Keep one at the sink but also another in the car, and one in the kitchen to give at opportune times.

*Self feeding: start with a Nuk brush or massage head brush to dip into applesauce or easy scoop able foods such as that!

Parents may want to order: "Fine Motor Skills in Children with Down's" by Maryanne Bruni as it has a lot of great ideas for self help, fine motor, and academic skills. This is found on Amazon used books for under $20 and is a great resource to have! She also has a gross motor book for Down Syndrome as well! Easy to read and parent friendly! Great for teachers also!