الفهرس 
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Abstract
Down syndrome is incurable and efforts to manage the condition are only focused on early childhood intervention, education and proper support and care (Mandal, 2014). Because massage therapy is a passive treatment that requires little physical demands on the individual receiving the therapy, and because massage therapy has been shown to develop muscle tone for other children, massage therapy might enhance physical development for children with Down syndrome. If increasing muscle tone facilitates motor functioning, then children with Down syndrome receiving massage therapy would also be expected to show improved motor functioning (Reif et al., 2006).
The purpose of the study were to:-
1. Assess the effect of therapeutic massage on improving muscle tone in children with Down syndrome.
2. Assess the effect of therapeutic massage on improving motor functioning in children with Down syndrome.
3. Assess the effect of therapeutic massage on children’s developmental gains such as fine motor, gross motor, self-care (feeding, toileting, dressing/hygiene skills) social/emotional, language and cognition.
Hypothesis:-
- Children with Down syndrome who receive therapeutic massage had more improved muscle tone, motor functioning and developmental gains.Research design:-
A quasi-experimental research design was used.
Settings:-
This study was conducted at the following settings in Menoufia governerate:-
1. El Basama center for children with special needs at Shebeen El-Kom city
2. El Basama center for children with special needs at Tala city
3. Wogod center for children with special needs at Shebeen El-Kom city
Sample:-
A purposive sample of 60 children diagnosed with Down syndrome were selected from the previously mentioned settings. The children were randomly assigned into two equal groups (30 children for each group).
Inclusion Criteria:
1. Age of children with Down syndrome ranged 1-4 year.
Exclusion Criteria
1. Children with severe emotional and physical impairment because massage therapy will not improve them.
2. Children with bone and joint diseases or other muscloskeletal disorders.
Instrument of the study:-
Four instruments were utilized for data collection:
Instrument one: A structured interview questionnaire sheet (Appendix I). It was composed of three parts as the following:
Part one: it includes Child’s socio-demographic data Part two: it involves child’s medical data
Instrument two: Arm, Leg& Trunk muscle tone scale (Appendix II).
Instrument three: Gross Motor Function Measure (GMFM) (Appendix III).
Instrument four: Developmental Profile for Infants and Young Children (DPIYC) (Appendix IV).
The main results of the study showed that:
1. The mean age of children was 2.37 ± 0.61 in the study group compared to 2.50 ± 0.63 in the control group.
2. All children in the two studied groups had hypotonia.
3. Children in study group had better arm and leg muscle tone on post massage therapy than on pre-test.
4. Also, on post massage therapy children in the study group had better muscle tone than children in the control group.
5. Children in the study group had better motor functioning score on post massage therapy than on pre massage therapy regarding lying and rolling, sitting, crawling and kneeling, standing and walking, running and jumping.
6. Children in the study group had better motor functioning scores than children in the control group on post massage therapy regarding lying and rolling, and walking, running and jumping.
7. Children in the study group had better motor functioning scores than children in the control group on post massage therapy regarding sitting, crawling and kneeling and standing.
8. Children in the study group had more mature developmental profile in weeks on post massage therapy sessions.9. Children in the control group had mature developmental profile in weeks for physical and motor development and social development. Meanwhile, there are no changes in self-care, cognitive and communication development.
10. Children in the study group had more mature developmental profile than children in the control group on post massage therapy regarding physical and motor, self-care and cognitive development.
11. There were negative correlation between total muscle tone and total gross motor function measure and developmental profile for both study and control group.