When working with individuals diagnosed with Down syndrome, physical therapy often focuses on more than just movement—it’s about building confidence, independence, and quality of life. This case study highlights the progress of one patient who began therapy in June 2025 with concerns about balance, functional mobility, and endurance.
Starting Point: June 2025
Patient is a 28-year-old female with Down syndrome. At the initial assessment, standardized measures painted a clear picture of the challenges ahead. The patient’s balance confidence, measured by the ABC Scale completed with assistance from the patient’s caregiver, was 56.9%. Functional mobility scores included a Berg Balance Scale (BBS) of 47/56, Functional Gait Assessment (FGA) of 17/30, and only seven repetitions on the 30-second Sit-to-Stand test. These numbers reflected limited confidence, strength, and endurance, but also an opportunity for growth.
The first phase of therapy focused on a standard PT program emphasizing strength, cardiovascular fitness, and balance. Sessions were dynamic and engaging, incorporating boxing drills, ladder exercises, obstacle courses, dual-task challenges, dance fitness, and cardio equipment like the treadmill and NuStep. The goal was to make therapy both effective and enjoyable.
Initial Assessment Summary:
- ABC Scale: 56.9% confidence
- Berg Balance Scale (BBS): 47/56
- 30-second Sit-to-Stand: 7 repetitions
- Functional Gait Assessment (FGA): 17/30
Midpoint Progress and Transition to LSVT BIG: August 2025
Two months later, progress was evident. The patient’s ABC confidence score rose slightly to 60%, and sit-to-stand performance nearly doubled to 12 repetitions—with the patient describing the task as “easy.” The FGA improved to 21/30, and endurance was measured at 347.7 meters on the 6-Minute Walk Test.
Progress Assessment Summary (Pre-LSVT BIG):
- ABC Scale: 60% confidence
- 30-second Sit-to-Stand: 12 repetitions (patient reported task as “easy”)
- FGA: 21/30
- 6-Minute Walk Test (6MW): 347.7 m
With these gains, the plan of care shifted to the LSVT BIG® protocol, a program designed to amplify movement and improve functional tasks. Therapy now emphasized large, purposeful motions through activities like sit-to-stands, half-kneel steps, and rotational reaching. This change aimed to address lingering balance confidence and enhance overall mobility.
Results of LSVT BIG: September 2025
By September, the transformation was remarkable. Balance confidence improved to 71.29%, and the FGA climbed to 25/30. The patient maintained 12 sit-to-stand repetitions—this time without any upper extremity support—and endurance improved to 403.4 meters on the 6-Minute Walk Test. Caregivers noticed smoother mechanics and greater efficiency in daily movements.
Final Assessment Summary (Post-LSVT BIG):
- ABC Scale: 71.29% confidence
- FGA: 25/30
- 30-second Sit-to-Stand: 12 repetitions (no upper extremity support)
- 6MW: 403.4 m
What We Learned
The initial phase improved strength and activity tolerance, but confidence gains were modest. After introducing LSVT BIG, the patient experienced significant improvements in balance confidence and gait performance, while maintaining strength and endurance gains. Although endurance remained below age norms, the overall progress was clinically meaningful.
This case suggests that LSVT BIG protocol may offer superior outcomes for individuals with Down Syndrome, particularly in boosting confidence and functional mobility—areas where traditional PT programs may fall short. While normative data for this population is limited, these results highlight the potential for targeted, amplitude-based interventions to make a real difference.
