Yoshihide Kanai

[Purpose] Flat feet frequently present in children with Down syndrome, necessitating a clinical evaluation and diagnosis. Therefore, a simple, low cost diagnostic method that can avoid radiation exposure is needed. This study was performed to investigate the intra-rater reliability of arch height ratio measurement using bone markers of the foot on the surface of the body in children with Down syndrome. [Participants and Methods] In total, 27 feet of 27 children with Down syndrome (16 male, 11 female) were included. We measured the length of each foot and the height of the navicular tuberosity on the surface of the body. The arch height ratio was calculated using the length and height. The same examiner performed three consecutive measurements of each of the two parameters. We calculated the arch height ratio using each of these measurements. The intraclass correlation coefficient [ICC(1,3)] of the length of the foot, height of the navicular tuberosity, and arch height ratio among the three measurements was obtained. [Results] The ICC of the height of the navicular tuberosity, length of the foot, and arch height ratio were quite high at 0.998, 0.999, and 0.997, respectively. [Conclusion] This study showed high intra-rater reliability of arch height ratio measurement using the length of the foot and height of the navicular tuberosity on the surface of the body in children with Down syndrome.

[Purpose] The general approach for flat foot (FF) treatment in people with Down’s syndrome (DS) is the use of insoles. However, the appropriate timing of the first insole prescription remains unclear. An aim of this present research was to investigate the status of prevalence of FF and orthosis prescription in the DS population. [Subjects and Methods] Two hundred fifteen subjects with DS who were seen at our hospital were retrospectively investigated. Investigated parameters were: prevalence of FF and other foot diseases, ratio and timing of orthopaedic consultation, ratio and timing of orthoses prescription, and mean age at the time of orthosis prescription. [Results] The prevalence of FF was 27.0% (58 subjects), and 50 subjects (23.3%) consulted an orthopaedic surgeon. An orthosis was prescribed for 54 subjects; 88.9% of these orthoses were insoles. Foot and leg orthoses other than insoles were prescribed significantly more frequently for females than males. The mean ages at the time of the first prescription of all types of orthoses and an insole were 7.3 years and 6.4 years, respectively. [Conclusion] The prevalence of FF was low, and the age at which subjects with DS were prescribed an orthosis was relatively high at our institution compared to previous reports. Since physical therapists see patients who could potentially have FF, those with suspected FF should then be referred to an orthopaedic doctor, which would enable the earlier orthosis prescription.

[Purpose] This case study describes the reacquisition of knee joint function in a patient with Down syndrome after surgery for patellar dislocation using external focus training. [Participant and Methods] The patient was a female aged 24 years with Down syndrome and a low Intelligence Quotient, who suffered from right patellar dislocation. The range of motion in the right knee while walking was 2 to 23 degrees at 3 weeks after surgery. A compensatory gait while walking was confirmed, with her right leg fixed in extension. Her range of motion while lying was 0 to 155 degrees. A task in which the patient reached and touched a ball was performed with the lower extremities while lying down, according to simple instructions from a therapist. Instructions were given using a simple directive phrase. The intervention started with a single-joint exercise and progressed to a multi-joint exercise. [Results] The range of motion was 0 to 68 degrees at 9 weeks after surgery. Her compensatory gait disappeared and she was able to walk more than 2 km. [Conclusion] Even though the patient’s low cognitive function made it difficult for her to complete some tasks, training based on external focus enabled her to acquire adequate knee joint function. External focus training was found to be effective for a patient with a low Intelligence Quotient.

[Purpose] The Kyoto Scale of Psychological Development is an evaluation scale developed in the field of psychology. The initial aim of this study was to determine whether the quotient of the Postural-Motor area in the scale was correlated with the use of orthosis in patients with Down syndrome. The second aim was to examine a correlation among Postural-Motor, Cognitive-Adaptive, and Language-Social areas in the participants. [Participants and Methods] Patients with Down syndrome who had received a developmental examination, the Kyoto Scale of Psychological Development, were retrospectively investigated. The sample included 78 participants. Data on the participants’ calendar ages ranged from 4.1 to 6.0 years, and the mean age was 4.9 at the examination. The investigated parameters were the number of participants who used an orthosis or insole and the mean developmental quotient for the Postural-Motor, Cognitive-Adaptive, and Language-Social areas. [Results] Twenty participants who completed the exam used an orthosis, and 18 of these had an insole as a first orthosis. The mean Postural-Motor quotient was significantly lower in participants who used an orthosis than in those who did not (52.3 ± 14.7). [Conclusion] The mean quotient of the Postural-Motor area was significantly lower in patients with Down syndrome who were prescribed some kind of orthosis than in those who were not. There was a significant correlation among the quotients of the three areas. The use of orthosis was expected to positively influence the Cognitive-Adaptive and Language-Social areas through the future in people with Down syndrome who have some difficulty with posture and movement.