Effect of a 12-Week Intensive Physical Therapy Program on Gross Motor Function in a 2-Year-Old Child with Down Syndrome: A Case Study

Abstract

Background: Down syndrome is characterized by hypotonia, ligamentous laxity, and delayed motor development. Although early physical therapy is essential, optimal intervention strategies for improving gross motor milestones remain under investigation. Objective: This case study evaluated the effects of a 12-week, intensive physiotherapy program on the gross motor function of a 2-year-old child with Down syndrome. Methods: A 2-year-old female child was brought to pediatric physiotherapy clinic. She was a full-term infant born to a 34-year-old mother after an uncomplicated pregnancy. She has a known history of a ventricular septal defect, which is being monitored conservatively. Parents have experienced significant delays in achieving their motor milestones. She gained head control at eight months and achieved independent sitting at 18 months. Currently, at two years of age, she is not yet able to pull to stand, cruise on furniture, or walk. Clinically, she presents with the characteristic features of DS, including generalized hypotonia and significant proximal muscle weakness in the hips and shoulders. This is compounded by generalized joint hypermobility, particularly in ankles, knees, and wrists. She was a socially engaging child who participated willingly in therapy sessions. Informed consent was obtained from the parents of the participant for both the intervention and the publication of this case report. Gross motor function was assessed using the Gross Motor Function Measure-88 at baseline and after 12 weeks. A series of facilitatory techniques was initiated with sessions lasting 60 minutes a day, five days per week, for 12 weeks. Core strengthening was targeted via facilitated bridging, quadrupod, and kneeling activities, with reaching for toys, to build stability in the shoulders, trunk, and hips. Results: Substantial improvements were observed in all Gross Motor Function Measure-88 dimensions, particularly in crawling and kneeling (24% to 65%), standing (20% to 55%), and walking, running, and jumping (10% to 30%). The total Gross Motor Function Measure score increased from 49.2% to 69%, reflecting a 20% overall gain. Conclusion: A structured, intensive, and task-specific physiotherapy program led to significant improvements in gross motor skills in a young child with Down syndrome, suggesting it may accelerate motor learning in this population.