Motor development for individuals with Down syndrome – An overview
Ben Sacks and Sue Buckley
The term motor development covers a wide range of important human skills, from sitting, walking and running, to independent drinking, eating and dressing, to writing, drawing and using a keyboard, to sports and dance, and to work related skills such as operating machinery or packing. Most of us take our motor skills for granted, as most are performed easily and effectively without the need for conscious control, but, in fact, all movements require fast and complex control by the central nervous system, and motor control is still not fully understood by researchers in this field. In this overview, research into the development and control of movements in typically developing individuals is discussed, and compared with the research into the motor development of individuals with Down syndrome, in order to identify evidence-based principles on which to base effective interventions. The research studies indicate that the pattern of motor skill development for individuals with Down syndrome is largely one of delay rather than difference, though attention needs to be given to developing strength and balance, and that they learn most effectively visually, from imitating a model, rather than from verbal instruction. The most effective way in which to improve motor skills for any individual is with practice, and studies have shown that individuals with Down syndrome need more practice than typically developing individuals to improve their performance. Most teenagers and adults can continue to develop their motor skills and many will achieve high levels of skill if given the opportunity.
Sacks B, Buckley SJ. Motor development for individuals with Down syndrome – An overview. Down Syndrome Issues and Information. 2003.
In the first year of life, infants begin to gain control
over movements – they begin to be able to hold their heads steady, to reach out
and grasp objects, to roll, sit and crawl and to hold cups or bottles for feeding.
They then go on to walk, run, climb stairs, use a spoon, knife and fork, and dress
themselves. Later they draw, write, use the computer, play football and dance. We
tend to take our movement abilities for granted as, for most of us, they have developed
effortlessly and most are carried out as we go through our day without conscious
attention to them at all. However, there is a large research literature devoted
to trying to understand how the brain controls our everyday movements so skilfully,
and the processes are still not fully understood. In the first section of this overview
we will discuss the current views of the motor research experts, as it is relevant
to our understanding of progress for children with Down syndrome.
Many babies and young children with Down syndrome are
late to reach the early motor milestones such as grasping, rolling, sitting, standing
and walking. There is wide variability in progress, with some reaching these milestones
as early as typically developing infants and some being particularly slow in achieving
them. Most parents are advised that physiotherapy will help, but do we actually
know the reasons for this slower progress in order to provide guidelines for effective
therapy? Do we know if physiotherapy actually makes any difference to progress and,
if so, how? Is the motor progress of children with Down syndrome just delayed (i.e.
slower but otherwise the same as in other children) or is it actually different
– due to physical differences in their muscles, ligaments or central nervous systems?
Whatever the answers to these questions, we know from
our own practical experience and research that the majority of children with Down
syndrome achieve all the basic motor skills necessary for everyday living and personal
independence. They may be later to achieve them and their movements may seem a little
clumsy or less refined as they carry out tasks but they still have adequate skill
for daily competence. Many continue to improve and refine their abilities in daily
tasks such as handwriting, making a cup of tea, and tying shoelaces, well into adult
life. They may have more difficulty in becoming skilled in games and recreational
activities but many individuals do reach high levels of achievement when given the
Research into the motor development and motor skills of
children and adults with Down syndrome is limited and, as we have studied the available
information, we have come to believe that some unhelpful myths keep being repeated,
without supporting evidence. One of these myths is hypotonia, or 'poor muscle tone'.
Almost every article we have read has used hypotonia as an explanation, when in
fact it probably plays little part in determining children's motor progress. We
will return to this issue later.
In this overview, we consider four questions.
- What do we
know about motor development in typically developing children and the factors
that may influence rates of progress or levels of skills achieved for different
- What do we know
about the pattern of motor development usually seen in infants, children and
teenagers with Down syndrome?
- What do we know about the effects
of therapeutic interventions?
- Can we draw on these three sources of evidence to identify some
principles for effective
intervention and activity programmes for individuals with Down syndrome
across the age range?
Before we can discuss motor skills, we need to recognise
that the term covers a wide range of activities and actions, and we have divided
them into somewhat arbitrary groups in order to more conveniently discuss therapies
and interventions later.
What are motor skills?
The ability to move is essential to human development,
and children develop a remarkable range of motor skills from the first year of life
through to adult life. Some are essential to basic human development and others
are specialised and optional. For practical purposes, motor skills can be considered
under two main headings:
- basic skills necessary for everyday life activities, and
- recreational, employment or specialist skills which are optional and based
on interests and aptitudes.
Basic skills include sitting, walking, running, climbing
stairs, picking up objects, using cups, knives and forks, pouring drinks, dressing
and managing fastenings, holding and using pencils, pens, scissors and using keyboards.
Recreational skills include skipping, throwing, catching,
hitting and kicking balls, riding a tricycle or a bicycle, swimming, skiing and
all sporting activities, playing a musical instrument and playing computer games.
Employment skills may be specific to a particular job and involve learning to operate
machinery. They may also be an extension of basic daily living skills, such as those
used in catering or gardening work.
Basic skills are usually further divided into gross motor
skills and fine motor skills.
- Gross motor skills are those concerned with whole body movement including
sitting, walking, running and climbing stairs.
- Fine motor skills tend to be those requiring fine manipulation of fingers
and hands including picking up objects, using cups, knives and forks, pouring
drinks, dressing and managing fastenings, holding and using pencils, pens, scissors
These divisions are somewhat arbitrary and do not imply
the use of separate parts of the motor system, as elements of gross motor control
such as maintenance of balance and body posture play a part in carrying out all
fine motor activities. However, they provide a useful practical way of dividing
the whole range of possible motor skills and they link with the sources of therapy
and teaching available to children and parents. Physiotherapists tend to be expert
in the development of basic gross motor skills and occupational therapists tend
to be experts in basic fine motor skills, although their skills will often overlap.
Recreational skills tend to be taught by teachers, physical education experts, sports
coaches and specialists such as music teachers. Employment skills may be taught
by supervisors or job coaches.
We have not included speech-motor skills in this discussion,
as the ability to talk, while a motor skill, is ill-understood, and is influenced
by the ability to hear and store the sound patterns of words (phonology). Speech
is therefore specialised and different, in at least some ways, from other motor
skills. Some information on speech-motor development can be found in the speech
and language books in this series.
Movement influences social and cognitive progress
While progress in basic gross and fine motor skills is
important because the ability to carry out the movements has direct and practical
benefit on a child's daily living and independence, motor progress is also important
because these abilities influence social and cognitive development as well. The
following list gives just a few examples of these links:
- being able to reach and grasp allows a child to begin to explore the characteristics
of objects in his or her physical world;
- being able to sit increases the ability to use arms and hands for playing;
- being able to walk allows a child to carry toys and objects and to explore
the world more effectively than crawling on hands and knees;
- being able to move independently also increases opportunities for social
interaction and language learning. For example, once a child can move, they
can go to see what happens when a visitor comes to the door or the telephone
rings. They can follow their carers around so that they are talked to and included
in everyday activities;
- being able to run, jump, climb and catch a ball increases a child's ability
to join in games in the playground;
- being able to dance, swim or play football increases opportunities for leisure
activities and friends, from childhood to adult life.