134 lines
6.4 KiB
TypeScript
134 lines
6.4 KiB
TypeScript
|
import Article from "@/components/Article";
|
|||
|
|
|||
|
const ArticlePediatricDownSyndrome = () => {
|
|||
|
return (
|
|||
|
<Article
|
|||
|
title="Down Syndrome"
|
|||
|
author="Richard A. Feely, D.O., FAAO, FCA, FAAMA"
|
|||
|
>
|
|||
|
<p>
|
|||
|
One might wonder what the value of osteopathic manipulative treatment
|
|||
|
could be for a genetic syndrome. Osteopathic medicine is based on the
|
|||
|
principle that body structure and function are dynamically interrelated.
|
|||
|
When one improves the anatomic interrelationships of structural elements
|
|||
|
of the body (bones, muscles, membranes, tissues, fluids), one sees
|
|||
|
improvement in the function of the body. This holds true whether the
|
|||
|
causes of the structural abnormalities are genetically based or not. It
|
|||
|
is clearly evident in looking at the face of a typical child with Down
|
|||
|
Syndrome that there is a lot about structure that is less than optimal.
|
|||
|
Let’s look at what improvements in functions might be seen by improving
|
|||
|
the structure.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Down Syndrome, or Trisomy 21, occurs in about one in 800 births. It is
|
|||
|
almost always the result of a third copy (trisomy) of some or all of the
|
|||
|
genetic material on chromosome 21. Intellectual developmental disorder
|
|||
|
and low muscle tone are probably the two most common hallmarks of Down
|
|||
|
syndrome. There is also a much higher than normal incidence of heart and
|
|||
|
gastrointestinal tract defects which often require surgical correction.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Many external body features are characteristic of the syndrome. These
|
|||
|
include among others, an upward slant to the eyes; skin folds at the
|
|||
|
inner edges of the eyes; a flat, wide bridge of the nose; small, low-set
|
|||
|
ears; a shortened front to back dimension of the skull; a recessed
|
|||
|
midportion of the face and a protruding and often furrowed tongue. Some
|
|||
|
of these features contribute to the health complications seen in Trisomy
|
|||
|
21, and some may plat a role in the common neurodevelopmental problems.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Changes in most features are possible through osteopathic manipulative
|
|||
|
treatment, and the improvements made structurally are likely to result
|
|||
|
in better functioning.
|
|||
|
</p>
|
|||
|
|
|||
|
<h2>Infections</h2>
|
|||
|
|
|||
|
<p>
|
|||
|
It is commonly accepted that most children with Down Syndrome have more
|
|||
|
severe respiratory infections, especially of the ears and sinuses. There
|
|||
|
are two reasons for this. One is the genetics of Down Syndrome causes
|
|||
|
abnormalities in the immune system which make it more difficult to
|
|||
|
resist an illness once exposed and harder to heal from it once ill. The
|
|||
|
second reason lies in the structure of the facial features which makes
|
|||
|
drainage of these areas more difficult.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
The midportion of the face (the area between the eyes and mouth) is
|
|||
|
small and typically set further back in the child with Down Syndrome.
|
|||
|
This means that the sinus cavities are smaller than normal and sometimes
|
|||
|
absent entirely. The wide, flat bridge of the nose blocks the openings
|
|||
|
through which the sinuses drain. The problem is compounded by the
|
|||
|
low-set position of the ears and the smaller than normal diameter of the
|
|||
|
eustachian tube which drains the middle ear to the back of the throat.
|
|||
|
When fluids fill the ears and sinus–spaces that should be occupied by
|
|||
|
air-infections are likely to occur.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Drainage is further compromised by the differential growth of the upper
|
|||
|
and lower jaw bones. The upper (maxilla), being part of the midface, is
|
|||
|
small in comparison to the lower (mandible). This also promotes the
|
|||
|
mouth breathing, protruding tongue and difficulty enunciating language
|
|||
|
often see in trisomic children.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Through a very gentle touch, an osteopathic physician trained in the
|
|||
|
cranial concept, can help to normalize the relationships of the bones
|
|||
|
and membranes of the of the facial area. By assisting the midface
|
|||
|
structures to come forward, one can see a cosmetic change in eye shape,
|
|||
|
cheekbones, tongue/mouth relationship and bridge of nose. Usually the
|
|||
|
frequency of upper respiratory infections are reduced as well.
|
|||
|
</p>
|
|||
|
|
|||
|
<h2>Growth Concerns</h2>
|
|||
|
|
|||
|
<p>
|
|||
|
Almost all children with Down Syndrome show delays in gross motor, fine
|
|||
|
motor developmental and language development. These skills often lag
|
|||
|
four months behind at one year of age and eight to ten months behind at
|
|||
|
two years of age. Language is frequently not gained until the fourth to
|
|||
|
sixth year. Though these delays are assumed to be genetically
|
|||
|
predetermined, let’s look at the role that body structure might play.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Osteopathic theory asserts that neural pathways in the brain are
|
|||
|
designed to lay themselves down in precise geometric relationships. When
|
|||
|
the cranium (skull) is distorted in its shape, it is not possible for
|
|||
|
these pathways to develop normally.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
There are several factors contributing to the distorted cranial shape.
|
|||
|
The sutures, where one bone meets another, are often positioned
|
|||
|
abnormally in Down Syndrome. The membranes that encase the central
|
|||
|
nervous system and lie between the brain and the cranium have a powerful
|
|||
|
effect on the growth of the developing skull. These dural membranes
|
|||
|
usually demonstrate very poor mobility in the trisomic child. The front
|
|||
|
to back dimension of the cranium is typically shortened in Down Syndrome
|
|||
|
and is one more factor dictating distorted geometry for the developing
|
|||
|
neural pathways.
|
|||
|
</p>
|
|||
|
|
|||
|
<p>
|
|||
|
Osteopathic treatment can effect significant changes in the shape of the
|
|||
|
cranium through addressing the sutures and the tensions in the dural
|
|||
|
membranes. The distortion of the cranial mold appears to contribute
|
|||
|
significantly to the difficulty in performing coordinated motor tasks
|
|||
|
such as grasping and crawling. Most agree that mastery of these tasks is
|
|||
|
a necessary foundation for later learning. Osteopathic treatment,
|
|||
|
therefore, is an important part of the health plan for a child with Down
|
|||
|
Syndrome.
|
|||
|
</p>
|
|||
|
</Article>
|
|||
|
);
|
|||
|
};
|
|||
|
|
|||
|
export default ArticlePediatricDownSyndrome;
|