‘Does Fine Motor Skill competence training of children with Down syndrome affect their performance on classroom activities?’

The study setting will be government schools in Matara district where children with Down syndrome are studying but the intervention will be administered in child’s own home.

A cluster will be defined as ‘a government school having children with Down syndrome in Matara district’

Method of randomization is cluster randomization. The clusters will be assigned as intervention and control groups by simple randomization using a random number table.

The intervention will include two major activity areas as warm-up activities and fine motor activities. Warm up activities will be practiced prior to fine motor activities.

There will be two sets of warm up activities and four fine motor activities to be practiced as follows.

There will be three sets of activities for two weeks each as mentioned below.

1st and 2nd week: Two warm up activities and four fine motor activities

3rd and 4th week: Two warm up activities and four fine motor activities

5th and 6th weeks: Two warm up activities and four fine motor activities

The above activities will be repeated for the intervention group for a further 6 weeks.

Parents will be trained on how to administer the intervention during a half-day session.

Parent (Principal caregiver) will deliver the intervention to the child by practice of the above activities with the child once a day for 30 min each. The intervention will be administered four days per week on a one-to-one basis for 12 weeks for intervention group and 6 weeks for control group.

Standard therapy will be the usual school activities conducted in the classroom by teachers and will include:

1.Pencil work- write letters and numbers, draw pictures

2.Scissor work- cut a paper along a line/circle/square 3.Glue work-paste pieces of paper inside the given pictures 4.Reading and singing. 5.Colouring pictures

Standard therapy is common to both groups in the classrooms by the class teacher.

In addition to the standard activities the intervention group will receive exercises to be done at home under the supervision of the caregiver to improve fine motor skills. The activities in the intervention of fine motor skills will improve: Finger strength, finger opposition, in-hand manipulation, finger extension & flexion, reaching, coordination, wrist stability and arches Fine Motor activities in the intervention include: 1.Make a clay ball 2.Drawing on the wall 3.Tightly hold the ribbon 4.Putting coins into a box 5.Squeezing a sponge 6.Clay work (basic) 7.Rubber band hand 8.Making a string beads 9.Clay work (Advance) 10.Put cloth pegs around the paper plate 11.Cut the paper using the scissor 12.Use pencil sharpener

During the first six weeks of the trial, intervention group will receive both the intervention and standard therapy while the control group will only receive standard therapy.

During the second six weeks both intervention group and the control group will receive the intervention and standard therapy.

• Children with a confirmed diagnosis of Down Syndrome and having fine motor deficiency

• Children aged between 6-9 years

• Both male and female children.

• Children with no visual impairments, medical or genetic conditions beyond those associated with Down Syndrome.

• Absence of a diagnosis of a co-existing autism spectrum disorder as reported by the parents

• Student who attends a regular or special education class in a government school in the Matara district

• Children with a principal caregiver who is willing to get involved actively in implementation of the intervention.

• Children with DS who do not have fine motor deficiency.