Down syndrome is a type of mental retardation that has an effect on motor development of children. Neuromuscular abnormalities in children with Down syndrome, which have been observed to be coincident with developmental delays, include generalized muscular hypotonia, the persistence of primitive reflexes beyond their normal disappearance with age, and slowed reaction times during voluntary movement. 1,2 Children with Down syndrome have a predominance of primitive, spinally controlled muscle response patterns over more centrally integrated and co-ordinated movement patterns. This is due to poor myelination of the descending cerebral and brain stem neurones, and a reduction in both the number and connections of neurones in higher nervous centers, such as the motor cortex, basal ganglia, cerebellum and brain stem. Based on behavioral observations of develop- mental delay, clinicians have conducted a number of research projects involving early therapeutic intervention for children with Down syndrome. These studies have attempted to facilitate normal mental and motor development through a variety of stimulation techniques, with mixed results. 2–4 Automatic postural reactions are considered to be essential components of motor behaviors. Postural reactions work together as a unified system to maintain body alignment and proper posture during movement. 5 Infants with Down syndrome have delayed motor development, including a delay in postural reactions. 6 When motor development of a child with Down syndrome is compared with that of a developmentally normal child, a Pediatrics International (2003) 45, 68–73 Clinical Investigations Comparison of different therapy approaches in children with Down syndrome MINE UYANGK, GONCA BUMIN AND HÜLYA KAYGHAN Hacettepe University School of Physical Therapy and Rehabilitation, Occupational Therapy Unit, 06100 Samanpazarı-Ankara, Turkey Abstract Background: Children with Down syndrome have sensory integrative dysfunction as a result of limited sensory experience from lack of normal motor control. The aim of the present study was to compare the effects of sensory integrative therapy alone, vestibular stimulation in addition to sensory integrative therapy and neurodevelopmental therapy, on children with Down syndrome. Methods: The present study was carried out at the Occupational Therapy Unit, School of Physical Therapy and Rehabilitation of Hacettepe University. Forty-five children who were diagnosed as having Down syndrome by the Departments of Paediatric Neurology and Medical Genetics at Hacettepe University were assessed and randomly divided into three groups. Sensory integrative therapy was given to the first group (n=15), vestibular stimulation in addition sensory integrative therapy was given to the second group (n=15) and neurodevelopmental therapy was given to the third group (n=15). All children were evaluated with Ayres Southern California Sensory Integration Test, Pivot Prone Test, Gravitational Insecurity Test and Pegboard Test. The hypotonicity of extensor muscles, joint stability, automatic movement reactions and locomotor skills were tested. Treatment programs were 1.5 h per session, 3 days per week for 3 months. Results: When these groups were compared, statistically significant differences were found in subjects’ performance of balance on right foot-eyes open, pivot prone position–quality score and locomotor skills-front tests (P<0.05). There were no significant differences in the other tests (P>0.05). Conclusion: The results of the present study showed that sensory integration, vestibular stimulation and neurodevelopmental therapy were effective in children with Down syndrome. It was concluded that when designing rehabilitation programs for children with Down syndrome, all treatment methods should be applied in combination, and should support each other according to the individual needs of the child. Key words Down syndrome, occupational therapy, physical therapy. Correspondence: Gonca Bumin, PT, PhD, Assist. Prof. Hacettepe University, School of Physical Therapy and Rehabilitation, 06100 Samanpazarı-Ankara, Turkey. Email: gbumin@hacettepe.edu.tr Received 10 July 2001; revised 12 June 2002; accepted 12 July 2002.