Effect of New Inventive Happy Strap in Children with Down Syndrome

Children with Down syndrome begin to develop orthopedic problems including inefficient gait pattern for walking early in childhood. To reduce the sequences of these orthopedic problems few treatment modalities such as serial immobilization casting, corrective splints and surgery were used. However, these modalities may delay the progression of neuro-motor development in a child. Alternatively, treatment model such as new inventive strap “Happy Strap” which correct deformities, increase stability and allowed child to walk and movement may be considered. The aim of this project was to examine the effects of newly developed strap on stability and walking patterns in children with Down syndrome. In this Randomized controlled trials eight children aged 18 months to 4 years were randomized to an experimental (Happy strap) children or a control group. All 8 children were assessed without the strap, on and immediately after using the strap for experimental group and at 3 months for both groups using the Gross Motor Function Measure (GMFM) (standing, walking and running, jumping dimensions). The strap was applied for 24 hours a day every day for the 3-month intervention period. Results revealed that there is improvement of motor function for both groups but it was better in children who worn happy strap for 3 months. For experimental group the total mean of GMFM was improved from 172.45 ± 6 before applying the strap to194.32 ± 2 after. In conclusion: this study provides some preliminary evidence that happy strap may promote an improved motor function in young children with Down syndrome. However, larger sample size using more advanced measurement tools may reveal different findings. Key wores: Down Syndrome Strap GMFM Motor function INTRODUCTION function much more efficiently, early detection and Hypotonia, ligament laxity and motor alterations are with a Down syndrome is vital [10-13]. Limited information characteristic for children with Down syndrome (DS). suggested that, the treatment modalities used in the Motor disability is widespread among individuals with DS correction of congenital abnormalities in the child with it includes balance, postural deficits and cocontraction Down-syndrome are the same that would be used in the of agonist and antagonist muscles [2-4]. Additionally, normal patient [14-17]. These include serial immobilization children with DS begin to develop orthopedic problems casting, corrective splints and surgery. However, it has early in childhood and Caselli et al., reported that walking been suggested that immobilization modalities that impede in children and adolescents with DS was characterized by walking, such as plaster casts or restrictive splinting, a pattern with external rotation and abduction of the hips, should be avoided, since these can further delay the increased knee flexion and valgus and external rotation of progression of neuro-motor development in a child that the tibia [5]. One problem is that, this is an inefficient gait will already exhibit a significant delay in learning to walk. pattern for walking. If this pattern is allowed to persist, Alternative method of intervention may be considered problems will develop with both the knees and the feet, which correct deformities, increase stability and allowed walking will become painful and endurance will be child to walk and movement is recommended. However, decreased. These problems tend to progressively worsen there are limited number of studies about physical as the clinical picture advances, severely limiting the intervention or/ and the use of strap or splint to prevent patients ‘quality of life [6-9]. In order to decrease the these deformities in children with DS. Additionally, a new severity of these problems and allow the individual to inventive strap “Happy Strap” which has been designed intervention of these physical consequences in a child World J. Med. Sci., 8 (3): 276-278, 2013 277 by parents of child with DS as an aid for infants and administered: The Gross Motor Function Measure children with hypotonia (low muscle tone) to assist the (GMFM) (standing, walking, running, jumping control of ligament laxity and joint flexibility in the hip dimensions) and Bruninks-Oseretsky Test of Motor joint. However, there is no previous research/ study to Performance (BOTMP) (balance subtest). At this stage investigate the effect of “happy strap” in walking pattern only data from the GMFM is analyzed but upon and joints stability for children with DS. Thus, the aim of completed the entire study data from other measurement this project was to examine the effects of newly developed tools will be analyzed and correlated with each others. So, strap on stability and walking patterns in children with there is no sufficient data yet for proper statistical Down syndrome. analysis. METHODS Initial Results: No serious safety events were Design: Randomized controlled trials fractures, hip dislocations, or skin abrasions. Participants: we intended to recruit twenty children with motor function for both groups but it was better in Down syndrome but at this stage eight children aged 18 children who worn happy strap for 3 months. At this months to 4 years were randomized to an experimental stage it was not possible to analyze hip stability due to (Happy strap) or a control group (without happy strap). the lack of valid accessible tools, following discussions This study was approved by the Hashemite university with researchers and biomechanics scientists from various review board and a parent of each participating children’s’ research centers, it was suggested that the best way of families provided a consent. measuring the effects of happy strap on hip stability and Intervention (3 Months): In experimental group, happy to analyze the immediate and long term effects of happy strap was modified to fit children size in order to be strap on hip stability and quality of movement. appropriate for each child. Prior to “happy strap” application children’s mothers had received proper Limitations of the Study: At this stage there is only one orientation about the use of happy strap. All intervention measurement outcome was analyzed (GMFM). The for these 4 children was carried out at children homes but GMFM-66 is functional measures and may not detect GMFM tests were carried out at our rehabilitation lab. changes in gait and quality of movement, which may be Strapping Procedures: Happy strap was applied for size was used [only 8 children]. larger Larger sample size 24 hours a day every day for the 3-month intervention using more advanced measurement tools may reveal period. The mothers removed the strap for daily necessary different findings. child activities such as bathing, dressing etc and once a week for one hour to allow active range of motion and to Summary and Recommendation: This ongoing study is check skin integrity. the first ever study to examine the effects of happy strap Outcome Measurements: All 8 children were assessed Down syndrome. However, this study provides some without “ happy strap” on, immediately after using the preliminary evidence that happy strap may promote an happy strap for experimental group and at 3 months for improved motor function in young children with Down both groups. At this stage 2 measurements were syndrome. encountered or occurred during the study such as Table1 demonstrates that there is improvement of gait analysis in children with DS is by using motion tools important areas to consider. Additionally, small sample on motor function and hip stability in young children with Table 1: GMFM scores for both happy strap group and control groups, [N= 8 children with DS] Variable Happy strap group before Happy strap group after 3 months Control group before Control group after 3 months Mean(SD) Mean(SD) Mean(SD) Mean(SD) GMFM total 172.45 (6) 194.32(2) 182.7(8) 184.6(6) GMFM crawling and kneeling 34.7(3) 36.8(0.6) 33.9 (4) 34.2(4) GMFM standing 25.7 (5) 29.3(3) 22.5 (7) 23.8 (2) GMFM walking, running and jumping 18.4 (2) 21.6(08) 15.3(3) 16.5(1) World J. Med. Sci., 8 (3): 276-278, 2013 278REFERENCES9. Donoghue, E.C., B.H. Kirman, G.H.L. Bullmore, 1. Galli, M., C. Rigoldi, R. Brunner, N. Virji-Babul andaffecting age of walking in mentally retardedA. Giorgio, 2008. Joint stiffness and gait patternpopulation. Dev Med Child Neurol, 12: 781-92.evaluation in children with Down syndrome. Gait and 10. Peuschel, S.M., 1987. 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