Journal of Intellectual Disability - Diagnosis and Treatment, 2021, 9, 195-205 195 E-ISSN: 2292-2598/21 © 2021 Lifescience Global Current Approaches to Improve Balance in Down Syndrome Population-A Systematic Review Nazia Adeeb 1,* , Sumaira Imran Farooqui 2 , Abid Khan 2 , Jaza Rizvi 2 and Syed Abid Mehdi Kazmi 3 1 A.C.E.L.P (Institute of Child Development), 197/8, Rafiqui Shaheed Road, Opposite Jinnah Postgraduate Medical Centre, Karachi, Pakistan 2 Ziauddin College of Rehabilitation Sciences, Ziauddin University, Plot # E – 40/1- Wahid Colony Block – B North Nazimabad, Karachi, Pakistan 3 Dr. Ziauddin Hospital, 4/B Shahrah-e-Ghalib Rd, Block 6 Clifton, , Sindh 75600, Karachi, Pakistan Abstract: Down syndrome is one of the most common chromosomal disorders in pediatrics characterized by variable intellectual disability, generalized joint laxity, and hypotonia that compromises their function and causes a delay in developing gross motor skills, poor balance, and coordination. Thus, this study aims to determine the current yet effective treatment approaches to improve balance in the Down syndrome population. The studies were explored across seven electronic databases that include MEDLINE, PubMed, Cochrane Library, Google Scholar, Scopus, PEDro, and Web of Science from inception till October 2020 comprised of experimental studies published in English language investigating the effects on balance in children and adults diagnosed with DS considering different interventions. A total of 1,570 records were retrieved from seven electronic databases published between the year's tenure of 2013-2020. 144 full-text papers were extracted to be reviewed, of which only 18 experimental studies were selected on the basis of inclusion criteria that involved 493 Down syndrome patients, investigated the effects of therapeutic exercises, manual therapy techniques, and patient-related instructions on standardized balance scales/tests. It was concluded that all the included trials demonstrated significantly profound effects in improving the static and dynamic balance of Down syndrome patients. Therefore, none of the interventions is declared as superior to another in terms of obtained results. Furthermore, these diverse interventions need to be investigated more for better understating and generalizability of outcomes. Keywords: Down syndrome, Trisomy 21, Therapy, Proprioception, Equilibrium, Position Sense. INTRODUCTION Down Syndrome (DS), a subcategory of intellectual disability, is one of the most common chromosomal disorders in the pediatric population caused by full trisomy 21 (94%), mosaicism (2.4%), or translocations (3.3%) [1]. World Health Organization (WHO) documents the global incidence of children with Down Syndrome to be 1 out of 600-1000 live births [2]. The condition is characterized primarily by variable intellectual disability and peculiar physical features like distinct facial phenotype, short stature, and generalized joint laxity, and hypotonia with effect on health and development [3, 4]. Hypotonicity causes decreased muscular strength and activity tolerance and hypermobility in joints, compromising their function and delay in developing gross motor skills, poor balance, and coordination [1, 5, 6]. Evidence shows that motor development in this population has a different profile than that of a child without disabilities because the age category at which a specific motor level is reached is higher [7]. Besides, DS children may exhibit a wide *Address correspondence to this author at the A.C.E.L.P (Institute of Child Development). 197/8, Rafiqui Shaheed Road, Opposite Jinnah Postgraduate Medical Centre, Karachi, Pakistan; Tel: 021-3567557; E-mail: nadeeb@hotmail.com range of co-morbidities affecting various systems like respiratory, cardiac, immune, endocrine, etc. [8]. Despite this fact, survival has increased considerably in the last 50 years from < 50% in the mid-1990s to 95% in the early 2000s with a life expectancy of 60 years [9]. One of the reasons for this improvement can be attributed to advancements in medical technology with prenatal detection and early intervention. A paradigm shift is observed in society's attitude towards the normalization of the lives of people with DS [8]. This has led to a better state of health, a higher degree of autonomy, integration, and inclusion of this population in the community during the last two decades [8]. Despite all these advances, the incidence has also grown in the last decades, drawing the attention of scientists from various fields on its causes, forms of manifestation, and ways of treating the children diagnosed with this syndrome with the development of a comprehensive therapeutic approach [7]. Multiple studies suggested that DS children present with decreased balance, affecting motor skill proficiency and physical activity. Therefore, approaches that deal with this issue are of utmost importance as their participation in various walks of life is increasing as well as in athletic and sports events