“…In both children and adults with DS, impaired movement fluency and axial control, hypotonia, and disorders in coordination and body balance, that negatively affect gross motor skills, can be attributed to the decreased size of the corpus callosum and cerebellum, reduced superior temporal gyrus and reduced volume of the brainstem [ 7 , 10 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Moreover, in the DS population, physical features such as small hands, short fingers, laxity of ligaments, and lower thumbs can adversely affect fine motor skills such as manipulating small objects and using pencils [ 11 , 18 , 32 ].…”