Sunday, May 17, 2009

An Osteopathic Perspective on Down Syndrome


Osteopaths who deal with the treatment of infants are likely at some point to receive a phone call from a parent exploring the benefits of osteopathy for children with Down syndrome. In this article I will try to outline some of the more relevant areas around which an osteopath can build a treatment plan.

Downs syndrome is a chromosomal abnormality that results in a variety of changes in the structure of the face, head, eyes, ears, internal organs, muscles and central nervous system. A theory proposed by Nicholas J.R. Handoll D.O. (1) is that the altered developmental processes experienced by people with Down syndrome are not an inherent result of the chromosomal abnormality. Instead, they are the result of hypoxia of the central nervous system caused by compressed sinuses and regular respiratory infections that children with Down syndrome suffer from.

Children with Down syndrome present typically with a flat occiput and face, the maxilla and the mandible are often small, the mouth is open and the tongue protrudes giving the impression that the tongue is longer than usual. A high palate often affects speech and a tendency towards respiratory infections.

Sinus development is affected, particularly the frontal, ethmoid, maxillary and sinus bones which compress and compromise the airways and the respiratory tract function. An important consideration for the osteopath is the cranial base which is shorter antero-posteriorly due to the underdevelopment of the sphenoid. Furthermore, the nasopharynx is narrowed further reducing the capacity of the respiratory airways and oxygen saturation.

It should start to become clearer now how a child with Down syndrome is more vulnerable to upper respiratory and sinus infections. The facial and cranial changes are so profound that they are bound to lead to sinus and respiratory infections in the majority of children with Down syndrome. The osteopath should therefore pay special attention to the cranium and thorax in order to improve blood and lymph drainage in order to reduce infection in the respiratory airways.

Many children with Down syndrome need to have operations early on in life to correct visceral problems of the heart or the gut. The consequence of this is that scar tissue and secondary problems develop in the musculo-skeletal system. Children with Down syndrome also tend to be hypotonic affecting posture and gait.

Treatment should begin as soon as possible after birth when the tissues are still flexible and before growth spurts begin. At the beginning treatment may need to be concentrated and coordinated with growth spurts and seasonal changes.

In summary, based on the theory that much of the developmental dysfunction of Down syndrome is due to the postnatal hypoxia from airway obstruction, osteopaths are able to improve the development of the basocranium and viscerocrnium and function of the airways, reduce the chances of infection and improve oxygenation of the central nervous system and hence aid the natural development of the body.

1) http://www.cranial.org.uk/res/handoll/downs/index.htm