Purpose: Down syndrome (DS) is one of the most common chromosomal syndromes. Children with this diagnosis receive physical therapy from an early age to help with strength, stability, motor planning and to help them meet motor milestones. Although early intervention physical therapy is usually done in the home or daycare, it is important to explore different therapies and how those might positively affect the child's outcomes. This project presents the case of a young girl with Down syndrome who received both hippotherapy and pool therapy and uses evidence based analysis to look at the PICO question: In toddlers with Down syndrome, does pool therapy or hippotherapy provide better motor outcomes? Background: In children with Down syndrome, early intervention therapies, especially physical therapy, are important to help with strengthening, postural stability, and to decrease the use of compensatory patterns. It is important when working with children to find activities that are fun, that they want to participate in, and, in children with low levels of arousal, which will increase their level of arousal to increase alertness, participation, and tone. Although all babies with a diagnosis of Down syndrome are referred to physical therapy, not all receive aquatic therapy or hippotherapy, which are different environments for physical therapy. Aquatic therapy is helpful for children with Down syndrome because it works on trunk stabilization, core strength, and does not stress lax ligaments. It is fairly easy to access. A downside, is that it is not a viable option for children with G-tubes or who have recently had surgery. In a hippotherapy setting, children with Down syndrome work on weight bearing, core strength, stability, awareness and attention, and on receiving proprioceptive input. Hippotherapy would not be appropriate for the children with respiratory issues if it is outside, or who have serious ligamentous laxity in their atlanto-occipital or atlanto-axial ligaments, because it could be dangerous. Hippotherapy is less common, and people rarely continue to participate in hippotherapy throughout their lives due to decreased availability of hippotherapy settings. Case Description: Anna G. was referred for an initial developmental evaluation with Early Intervention when she was around 5 months old for a diagnosis of trisomy 21 with a developmental delay. At around 24 months old, her physical therapist decided to change her physical therapy from at-home therapy to pool therapy. Based on her diagnosis, Anna was allotted 8 hours of therapy per month, to be split between physical therapy and speech therapy. Due to the limited number of early intervention therapy hours approved each month for children with DS, Anna was not allowed to receive both hippotherapy and pool therapy at the same time. Outcomes: Anna demonstrated improved tone and movement across interventions and it is impossible to determine if one treatment is better than the other. She continues to participate in hippotherapy and Early Intervention physical therapy. Discussion: Research assessing hippotherapy and aquatic therapy for early intervention in children with Down syndrome is very limited. Based on current evidence both hippotherapy and aquatic therapy would be appropriate, however, hippotherapy is the most suitable therapy for working on weight bearing for increased tone and postural stability. More research with larger populations and follow up studies are needed.


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Document Type


First Advisor

Kathy Dieruf


Hippotherpy; Aquatic Therapy, Down Syndrome

Available for download on Monday, March 14, 2118