Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health – a systematic review

Abstract

Purpose Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF). Methods We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases. Results We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population. Conclusions Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals. IMPLICATIONS FOR REHABILITATION Children with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers. In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation. Training of postural control should address strategies that include natural environments and participation situations. The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.