Inclusion Criteria:  Trisomy 21 by genetic karyotype A confirmed diagnosis of Down syndrome by a paediatric neurologist, having no neurological or mobility disorders, independent standing and walking abilities, Joint Laxity , low muscle tone and psychomotor development deficits Normal vision and hearing  Exclusion Criteria:  A history of congenital heart defects and orthopedic surgery in the past year and severe mental retardation. Seizure Severe visual or auditory disturbances, Weight less than the 3rd percentile of Down syndrome Multiple sclerosis or epilepsy