Contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome: a systematic review of randomized controlled trials.

Balance problems are common in children with Down syndrome, affecting how they move and take part in everyday activities, so researchers have been testing a range of physiotherapy approaches to see what helps. This systematic review pulled together randomized controlled trials from the past decade that looked at balance-focused interventions in this population, including things like trampoline exercise, Pilates, hippotherapy, whole-body vibration, dual-task training, and vestibular stimulation, among others. Across 14 trials involving 462 children, improvements in balance-related measures were seen with many of these approaches, particularly when they were added to conventional physiotherapy rather than used alone. This is an encouraging pattern because it suggests several different types of programs, not just one specific technique, may support balance in these children.

However, the trials varied in methodological quality from fair to high, and the review's authors note that larger, higher-quality studies with longer follow-up are still needed before firmer conclusions can be drawn about which approaches work best and whether gains last over time.

If your child has Down syndrome, you may already know that balance and steady movement can be harder for them, which can affect walking, playing, and daily activities. Researchers looked at what physiotherapy approaches have been studied to help with this, using randomized controlled trials, the type of study designed to compare an intervention against another approach or no treatment fairly. Across 14 studies with a total of 462 children, several different types of exercise programs, including trampoline-based exercises, Pilates, hippotherapy (horse-riding based therapy), whole-body vibration, and others, were linked to improvements in balance measures.

This happened especially when these programs were combined with standard physiotherapy rather than replacing it. While these results are encouraging, the studies varied in quality, ranging from fair to high, and the review's authors say bigger, better-designed studies that follow children for longer are still needed. This means it isn't yet clear which specific approach works best or whether the improvements are lasting, so this should be seen as an early but promising picture rather than a settled answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review synthesized 14 randomized controlled trials (462 participants total) evaluating physiotherapy interventions for balance rehabilitation in children with Down syndrome, published between 2015 and 2025 and identified through PubMed and Scopus. Interventions spanned isokinetic training, trampoline-based plyometric exercise, Pilates, dual-task exercise, hippotherapy, whole-body vibration, foot muscle strengthening, swimming, kinesiotaping, and vestibular stimulation, reflecting a heterogeneous evidence base rather than a single dominant modality. Methodological quality, assessed via the PEDro scale, ranged from fair to high across the included trials, indicating variable risk of bias rather than a uniformly strong evidence base.

Improvements in balance-related outcomes were reported across this broad range of interventions, notably when combined with conventional physiotherapy programs, though the abstract does not specify pooled effect sizes or head-to-head comparisons between individual interventions, so it remains unclear whether any single approach outperforms others. The authors conclude that technology-assisted and task-oriented approaches merit consideration within pediatric practice, while explicitly flagging the need for larger, high-quality trials with long-term follow-up to strengthen confidence in these findings and clarify durability of effects.