Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)
ORIGINAL ARTICLE
Effectiveness of Occupational Therapy on Improving Eating
Independence in School Age Children With Down Syndrome at
Kendari Autism Service Center, Indonesia
Sri Wahyuni1, Anisa Purnamasari1, Faridah Mohd Said2, Nisha Nambiar2
1
Nursing Study Program, Faculty of Health Sciences, Mandala Waluya University, Kendari, Sulawesi Tenggara 93561,
Indonesia
2
Faculty of Nursing, Faculty of Applied Science; LINCOLN UNIVERSITY COLLEGE. No. 2, Jalan Stadium, SS 7/15, Kelana
Jaya, 47301, Petaling Jaya, SelangorDarul Ehsan, Malaysia
ABSTRACT
Introduction: Down syndrome is a genetic syndrome that causes sufferers to experience delays in growth, disability,
physical weakness and have a relatively low IQ.There are 8 million people with Down syndrome in the world, of
which 3,000-5,000 children are born with chromosomal abnormalities per year.Every child has a developmental
task, including children with Down syndrome.One of the developmental tasks that must be achieved by children
is to achieve independence.To achieve the level of independence in children with Down syndrome, children need
to get a therapy, one of which is occupational therapy.The purpose of this study was to determine the effectiveness
of occupational therapy on increasing the eating independence of school-age children with Down syndrome at the
Kendari Autism Service Center. Methods: The type of research used in this study was pre-experimental with a one-
group pretest-posttest design.The population in this study were 60 children with Down syndrome who were at the
Kendari Autism Service Center.The sampling technique was purposive sampling with a total sample of 52 people.
Results: The results of the study is eating independence before being given occupational therapy was in the indepen-
dent category with a median value (minimum-maximum) of 14.00 (0-36), after being given occupational therapy,
the respondents were in the independent category with a median value (minimum-maximum) of 57.00 (36-64).The
results of the Wilcoxon analysis showed that the value of p = 0.001 <0.05. Conclusion: The administration of occu-
pational therapy is effective in increasing eating independence in school-age children with Down syndrome at the
Kendari Autism Service Center.
Keywords: Occupational Therapy, Eating Independence, Down Syndrome, Children Aged School, Kendari Autism
Service Center
Corresponding Author: which 3,000-5,000 children are born with chromosomal
Sri Wahyuni, M.Kes abnormalities per year (3). The epidemiology of Down
Email: sriw5205@gmail.com syndrome has reached 8 million cases. In France
Tel: +62 853-9543-2668 the number of people with Down syndrome 2,690
cases consisting of 678 cases (25.2%) experienced
INTRODUCTION live births, 46 cases (1.7%) experienced fetal death
and 1,966 cases (73.1%) experienced termination of
Down syndrome is a genetic syndrome that is often pregnancy for anomaly related to orthodontic problems
found and easy to recognize in children.Down syndrome with anatomical structures related to the growth and
causes sufferers to experience delays in growth, development of the skull, jaw teeth or a combination of
disability, physical weakness and have a relatively low both that will affect the shape of the face. In addition, in
IQ (1). Initially, Down syndrome was seen as a disorder Ukraine it was reported that there were 4,550 cases of
caused by psychological factors, namely the pattern of Down syndrome where as many as 2,220 cases (48.8%)
parental caregivers who were not emotionally warm. experienced live births, 155 cases (3.4%) experienced
Down syndrome is defined as a developmental disorder fetal death and 2175 (49.8%) pregnancy terminations
with three main characteristics, namely impaired social for anomalies (4).
interaction, impaired communication, and limited
interests and imagination abilities (2). The Ministry of Health’s Basic Health Research stated
that in Indonesia there were 0.12% of people with Down
According to WHO, it is estimated that there are 8 syndrome in 2017. That number increased to 0.13% in
million people with Down syndrome in the world, of 2018. The same source stated that the prevalence of
Mal J Med Health Sci 187(SUPP2): 104-107, Jan 2022 104
Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)
Down syndrome children in Indonesia reached 300,000 who were at the Kendari Autism Service Center. The
people with a ratio of 1:1000 (5). Based on data from sampling technique was purposive sampling with a total
the Social Service of Southeast Sulawesi Province (2020) sample of 52 people.Standard Operating Procedures
the number of people with Down syndrome (Students and observation sheets were made by researchers and
with intellectual disabilities) has increased from 2019 used to obtain data in this study. Respondents will be
to 2020. From the available data, the number of people measured the level of independence before being given
with Down syndrome in 2019 was 470 cases, while occupational therapy.After that, intervention in the
in 2020 there were 1006 cases, with the most cases in form of occupational therapy was carried out to the
Konawe Regency 300 children (31.38%), followed by respondents for 4 sessions and continued to measure the
Kendari City 230 children (24.05% ), Buton Regency 202 level of independence after being given therapy.
children (21.1%), Muna Regency 175 children (18.30%)
and Wakatobi Regency 99 children (10.35%) (6). Ethical Approval
Ethical approval for this study was obtained from the
Every child has a developmental task, including children Mandala Waluya Kendari School of Health Sciences (Ref
with Down syndrome. One of the developmental No : 1006.D/STIKES-MW/VI/2020). The confidentiality
tasks that must be achieved by children is to achieve of participants is strictly protected.
independence. The independence that must be taught to
children, especially children with special needs is self- Statistic Analysis
development activities such as eating, drinking, toilet We use computer programs to perform data analysis.
training, bathing, tidying up toys and dressing without The analysis carried out, in this case is a univariate
the help of others. However, teaching independence is analysis carried out to describe each variable, namely
not an easy thing, especially for children with special the dependent variable is an increase in the eating
needs such as children with Down syndrome and autism independence of school-age children with Down
(7).To achieve this level of independence, children syndrome, while the independent variable is the
must be able to coordinate between motor, cognitive provision of occupational therapy. Bivariate analysis
and language abilities. The motor development of was conducted to determine whether or not the
children with Down syndrome is different from the effectiveness of occupational therapy on increasing the
development of other normal children. Independence eating independence of school-age children with Down
problems in children with Down syndrome, such as syndrome at the Kendari Autism Service Center was
difficulty combing their hair, buttoning their clothes, carried out.
learning difficulties, being unable to eat and fulfilling
daily activities (8). To achieve a level of independence RESULTS
in children with Down syndrome, children need to get
therapy that can support the process. One of the therapies The results of the univariate analysis were based
that can be given to children with Down syndrome is on the effectiveness of giving occupational therapy
occupational therapy.Occupational therapy is a therapy to increase the eating independence of school-age
that combines art and science to direct the patient to a children with Down syndrome at the Kendari Autism
selective activity so that health can be improved and Service Center before and after the intervention. Based
maintained, and can prevent disability through activities on the distribution of respondents by age group.Table
and work activities for people with mental or physical I shows that among the 52 respondents aged 3 years
disabilities(4).Occupational therapy is very useful for there were 29 respondents (55.8%), aged 4 years there
children in developing independence and increasing were 8 respondents (15.3%), aged 5 years there were
focus or concentration not only for children with Down 15 respondents (28.9%). Based on the distribution of
syndrome but also for autistic children in learning and respondents’ gender groups, it can be seen in Table I
interacting (9). that of the 52 research respondents, the number of male
respondents was more than female, male respondents
The purpose of this study was to determine the were 37 respondents (71.1%), while 15 respondents
effectiveness of occupational therapy on increasing the were female (28.9%).
eating independence of school-age children with Down
Table I: Distribution of Respondents by Age and Gender
syndrome at the Kendari Autism Service Center.
Variable n (52) %
MATERIALS AND METHODS Age
3 years 29 55.8
Sample 4 years 8 15.3
The type of research used in this research is pre- 5 years 15 28.9
experimental with one group pretest-posttest design,
Gender
which is an experimental design carried out on one group
Male 37 71.1
of subjects without a comparison group.The population
in this study was 60 children with Down syndrome Female 15 28.9
105 Mal J Med Health Sci 187(SUPP2): 104-107, Jan 2022
Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)
Before analyzing the intervention, the data were first children with Down syndrome have difficulties such as
tested for the normality of the intervention which was walking, eating, and cleaning themselves, they need
analyzed using the Shapiro-Wilk test. The results of the other people. Down syndrome children have intelligence
normality test in table II show that the -value before levels below 30. With this intelligence, down syndrome
being given occupational therapy is 0.023 (ρ-value children only have optimal intelligence equivalent to
<0.05) and after being given occupational therapy, the normal children aged 3 years (9,10).
-value is 0.014 (ρ-value <0.05) This value indicates that
the data distribution is not normal. Independent children will have good self-adjustment,
quality of life and greater self-satisfaction can carry
Table II: Normality Test
out self-management and can cope with everyday
Independent Eating ρ-value α Conclusion problems.The independence of children with Down
Before being given Occupa- 0.023 0.05 Abnormal syndrome will bring happiness to their parents and
tional Therapy siblings. However, there is a group of children with
After being given Occupa- 0.014 0.05 Abnormal special needs who from birth are expected to experience
tional Therapy
difficulties in establishing independence (11).Based on
the results of this study, after intervention in the form
Analysis of the effectiveness of the independence of of occupational therapy, the results were in the form of
autistic children before and after being given occupational increasing the respondent’s eating independence.In the
therapy, the intervention analyzed by testing (Wilcoxon), types of activity items, some children who previously
as shown in table III.The results of the analysis in table could not do activities at all or needed a stimulus, after
III show that in this study, the respondents who were not being given occupational therapy the child became
independent before receiving the intervention (pre-test) able to carry out activities on their own without being
were 51 respondents (98.1%), reduced to 3 respondents stimulated.
(5.8%) after receiving the intervention (post-test). While
the independent respondents before receiving the The occupational therapy given has a role in increasing
intervention (pre-test) were 1 respondent (1.9%) and independence in children with Down syndrome, this
increased after receiving the intervention (post-test) as is because occupational therapy can restore the main
many as 49 respondents (94.2%). So it can be seen that physical functions, increase joint space, muscle strength
there is a positive effect of occupational therapy on and coordination of movements that can increase the
increasing the independence of autistic children. independence of children with IQ below normal such
as Down syndrome.In children with Down syndrome
The statistical test (Wilcoxon) showed that the study IQ is very influential on growth and development, be it
results had a significant difference in increasing the motor development, language, cognitive and personal-
independence of autistic children before and after being social. Children with higher IQ levels will be quick to
given occupational therapy intervention with a p-value acquire and process information (stimulus) that has been
of 0.001 less than 0.05. Therefore, the occupational received (4).
therapy provided has effectiveness in increasing the
independence of autistic children at the Kendari autistic CONCLUSION
service center.
This study concludes that there is an effect of giving
DISCUSSION occupational therapy in increasing eating independence
in school-age children with Down syndrome at the
Trisomy 21, the presence of a supernumerary Kendari Autism Service Center.
chromosome 21, results in a collection of clinical
features commonly known as Down syndrome. Down ACKNOWLEDGEMENTS
syndrome is among the most genetically complex of
the conditions that are compatible with human survival The authors are thankful to the Kendari Autism Service
post-term, and the most frequent survivable autosomal Center for permitting the researcher to use the data
aneuploidy(10). Down syndrome children are a group collected during this intervention and to publish the
that it difficult to carry out activities independently findings. The authors are thankful to the participant
because of the limitations experienced. To increase children, therapists, and heads of autism services
independent assistance in carrying out their daily lives, without whose direct support this research would not
Table III: Independence of Autistic Children before and after Occupational Therapy
Independent Autism Children’s Eating Independent Not Independent Total Median p Value
(Min-Max)
n % n % N %
Before occupational therapy 1 1.9 51 98.1 52 100 14.00 (0-36)
0.001
After occupational therapy 49 94.2 3 5.8 52 100 57.00 (36-64)
Mal J Med Health Sci 187(SUPP2): 104-107, Jan 2022 106
Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)
have been carried out properly. 6. Southeast Sulawesi Provincial Social Service.
Down Syndrome Data Throughout Southeast
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