Contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome: a systematic review of randomized controlled trials
Clinical Snapshot
PICO Framework
| P — Population | Children and adolescents with Down syndrome |
| I — Intervention | Contemporary physiotherapy interventions targeting balance rehabilitation (including isokinetic training, trampoline-based plyometric exercise, Pilates, dual-task exercise, hippotherapy, whole-body vibration, foot muscle strengthening, swimming programs, kinesiotaping, and vestibular stimulation) |
| C — Comparator | Conventional physiotherapy programs, control/waitlist conditions, or alternative interventions |
| O — Outcomes | Balance-related outcomes and postural control measures in children with Down syndrome |
Bottom Line
This systematic review synthesises evidence from 14 RCTs (N=462) examining contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome. A diverse range of modalities — including trampoline exercise, Pilates, hippotherapy, whole-body vibration, dual-task training, and kinesiotaping — demonstrated improvements in balance-related outcomes, particularly when combined with conventional physiotherapy. The PEDro scale was used for quality assessment, with studies rated fair to high. However, the review has important methodological limitations: the search was restricted to two databases without grey literature, no meta-analysis was performed, GRADE assessment is absent, and no PROSPERO registration is reported. The average trial size of approximately 33 participants is small, and clinical heterogeneity across 10 distinct intervention types precludes definitive conclusions about which modality is most effective. For Australian clinicians working within NDIS-funded paediatric services, these findings are encouraging but not yet sufficient to mandate specific intervention protocols. A multimodal, patient-centred approach combining contemporary techniques with conventional physiotherapy appears reasonable. Clinicians should document outcomes using validated tools. Larger, well-registered RCTs with long-term follow-up and standardised outcome measures are urgently needed to strengthen this evidence base.
Key Findings
P Value: Not reported at the review level
Effect Size: Not quantified; narrative synthesis only. Improvements in balance-related outcomes were reported across multiple intervention types, particularly when combined with conventional physiotherapy
Primary Outcome: Balance-related outcomes and postural control in children with Down syndrome following physiotherapy interventions
Nnt Or Sensitivity: Not calculable from available data; no pooled effect sizes, NNT, or standardised mean differences reported
Confidence Interval: Not reported; no meta-analysis conducted
Clinical Application
Multiple intervention modalities reviewed (including trampoline exercise, Pilates, hippotherapy, whole-body vibration, swimming, and kinesiotaping) are broadly feasible in paediatric rehabilitation settings. However, some modalities (hippotherapy, isokinetic training) require specialised equipment or facilities. Dual-task and vestibular stimulation approaches are low-cost and readily implementable. Combination with conventional physiotherapy appears to enhance outcomes based on the narrative synthesis. In Australia, children with Down syndrome typically access physiotherapy services through the National Disability Insurance Scheme (NDIS), which funds evidence-based allied health interventions. The NDIS requires demonstrated functional benefit, making the lack of standardised outcome measures and long-term follow-up data in this review a practical limitation for funding justification. The RACGP and Paediatric Society of Australia support early intervention for children with Down syndrome. None of the reviewed interventions require TGA approval as they are exercise-based. PBS considerations are not directly relevant. Australian practitioners should note that while the review supports a multimodal approach to balance rehabilitation, the evidence base does not yet meet the threshold for definitive NDIS outcome reporting standards. Practitioners are encouraged to use validated outcome tools (e.g., Bruininks-Oseretsky Test, Pediatric Balance Scale) consistent with those used in the included trials. Children and adolescents with Down syndrome (trisomy 21) presenting with impaired balance and postural control, particularly those engaged in paediatric physiotherapy or rehabilitation programs
Abstract
Children with Down syndrome commonly present with impaired balance and postural control due to musculoskeletal, sensory, and neuromotor deficits, which may negatively affect functional mobility and participation in daily activities. Over the last decade, a variety of contemporary physiotherapy interventions have been investigated to improve balance in this population. The aim of this systematic review was to synthesize evidence from randomized controlled trials evaluating physiotherapy interventions targeting balance rehabilitation in children with Down syndrome. A systematic search was conducted in PubMed and Scopus for studies published between 2015 and 2025. Randomized controlled trials investigating physiotherapy-related interventions targeting balance in children and adolescents with Down syndrome were included. Two independent reviewers performed study selection and data extraction. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 14 randomized controlled trials involving 462 participants were included. The included interventions comprised isokinetic training, trampoline-based plyometric exercise, Pilates, dual-task exercise, hippotherapy, whole-body vibration, foot muscle strengthening, swimming programs, kinesiotaping, and vestibular stimulation. Improvements in balance-related outcomes were observed across a broad range of physiotherapy interventions, particularly when approaches were combined with conventional physiotherapy programs. Conclusion: Contemporary physiotherapy interventions appear to be associated with improvements in balance-related outcomes in children with Down syndrome. The findings of this review support the integration of technology-assisted and task-oriented rehabilitation approaches into pediatric physiotherapy practice. However, the overall methodological quality of the included studies ranged from fair to high, and further large-scale, high-quality RCTs with long-term follow-up are required to strengthen the current evidence base.
References
- 1.Kanopoulou, D., Norikov, A., Dimitriadis, Z., Chandolias, K., Vassou, C., & Besios, T. (2026). Contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome: a systematic review of randomized controlled trials. European Journal of Pediatrics. https://doi.org/10.1016/j.ridd.2024.104827
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