Positioning on Gross Motor Development March 16, 2016 Kristen - PowerPoint PPT Presentation

Back to Sleep, Prone to Play: Influence of Prone Positioning on Gross Motor Development March 16, 2016 Kristen Parker, PT, DPT Pediatric Physical Therapist Covenant Healthcare kparker@chs-mi.com

Objectives • What is prone positioning and why is it important • Brief literature review • Outline benefits of prone positioning on gross motor development • Review daily time recommendations • Review different prone positioning techniques and facilitation methods • Questions

Tummy Time • Important activity for gross motor development – Helps to build the strength and coordination needed for rolling and crawling and promotes interactive play • Endorsed by the American Academy of Pediatrics (AAP) – Back to sleep – Prone to play • All babies benefit from tummy time, including newborns

Theory of Gross Motor Development • Dynamical Systems Theory (DST) – Focuses on the relationship between internal subsystems (nervous system, musculoskeletal system), environmental factors and the demands of the task Task Internal Environmental

Prone Positioning and the Back to Sleep Campaign • Launched in 1994 • Aimed to decrease risk for Sudden Infant Death Syndrome (SIDS) • Since introduction of back to sleep campaign, risk for SIDS has decreased by greater than 50% • Has also led to decreased tummy time resulting in: – Decreased head control – Delayed gross motor development – Increased risk for positional plagiocephaly

The Effects of Prone Positioning on the Quality and Acquisition of Developmental Milestones in Four- Month-Old Infants • Purpose: Does awake prone positioning affect the development of gross motor skills? • Methods: • Parent questionnaire to determine amount of daily tummy time for each child • Gross motor assessment using the Alberta Infant Motor Scale (AIMS)

The Effects of Prone Positioning on the Quality and Acquisition of Developmental Milestones in Four-Month-Old Infants

The Effects of Prone Positioning on the Quality and Acquisition of Developmental Milestones in Four- Month- Old Infants • Results: • Time spent in prone was limited to less than 30 minutes for 60/100 participants • Median time spent in position when awake: • Supine: 2.5 hours • Prone: 0.5 hours • Time spent in prone when awake was significant to achievement of: • 7/21 prone milestones • 3/9 supine milestones • 3/12 sitting milestones

The Effects of Prone Positioning on the Quality and Acquisition of Developmental Milestones in Four-Month-Old Infants Fig. 1. Comparison of time spent awake in prone position for four-month old infants who did and did not achieve milestone (n = 100).

Prone Positioning and Motor Development in the First 6 Weeks of Life • Purpose: Does the back to sleep campaign affect gross motor development in babies? • Methods: • Parent questionnaire to determine amount of daily tummy time for each child and preferred sleeping position • Specific positioning of the head, trunk, and extremities were observed and graded during supine and prone positioning and pull to sit

Prone Positioning and Motor Development in the First 6 Weeks of Life Time Infants Spent in Prone While Awake 45 42.5 40 35 30 26 Percentage 25 17.5 20 15 9 10 3 5 2 0 No Prone < 10 min 10-30 min 30-60 min 60-120 min > 120 min Time (Minutes)

Prone Positioning and Motor Development in the First 6 Weeks of Life • Results: • 17.5% of babies spent no awake time in prone • Only 14% of babies could be considered prone babies (greater than 30 minutes) • Only 5% of babies achieved 60 minutes of tummy time per day • Prone infants (greater than 30 minutes): • Greater head control • Greater ability to turn head in prone • Improved head lift to 45 degrees • Improved ability to displace weight on upper trunk

Prone Positioning and Motor Development in the First 6 Weeks of Life Affect of Awake Time Spent in Prone on Upper Extremity Positioning 100 90 80 70 Percentage 60 50 88 82 40 30 45 41 41 20 39 35 35 10 3 3 0 Active Movement Push on Arms Elbow Slightly Midposition of Hands Open Behind Shoulder Forearm Upper Extremity Positioning <30 min in prone >30 min in prone

Benefits of Prone Positioning on Gross Motor Development • Facilitates improved neuromuscular development • Promotes antigravity extension resulting in balance of flexor and extensor patterns • Encourages development of extensor control of the head and neck • Promotes improved postural control • Promotes earlier development of gross motor skills including rolling, sitting, crawling and pulling to stand

Benefits of Prone Positioning on Gross Motor Development • Promotes infant exploration and play resulting in optimal and timely cognitive development • Promotes improved respiratory function • Decreases risk for and helps to correct positional torticollis • Decreases risk for and helps to correct positional plagiocephaly

Prone Recommendations • Prone positioning is okay for infants and encouraged following return from hospital • Must always be supervised • Must be performed on a firm surface • Multiple variations of prone positioning can be used for infants • Use of towel and activity rolls can be used to facilitate proper alignment • Prone positioning and play in prone should continue to be encouraged after the baby has begun to roll

Time Recommendations Minimum of 60 minutes of awake prone positioning per day • Can be broken down into short sessions of 3-5 minutes to meet baby’s tolerance and needs • Incorporate tummy time into daily activities • Pay attention to signs that your baby is getting tired such as crying or resting their face on the surface and be sure to end tummy time before your baby becomes fatigued

Prone Positioning Variations

Pectoral Facilitation in Prone

Prone Progression to Facilitate Rolling

Take Home Points • All babies should participate in a minimum of 60 minutes of awake prone positioning per day • Prone positioning is essential for the development of antigravity extension and extensor musculature • Prone positioning promotes development of gross motor skills • All babies should continue to be placed supine to sleep

Questions

References 1. Russell, DC, Kriel, Helena, Joubert, Gina, & Goosen, Yolande. (2009). Prone positioning and motor development in the first 6 weeks of life. South African Journal of Occupational Therapy , 39 (1), 11-14. 2. Jennings, JT, Sarbaugh BG, Payne, NS (2005). Conveying the Message About Optimal Infant Positions. Physical & Occupational Therapy In Pediatrics , 25(3), 3-18. 3. Monson, RM, Deitz, J, Kartin, D. (2003). The relationship between awake positioning and motor performance among infants who slept supine. Pediatric Physical Therapy, Research Report, 196-203. 4. Lobo, MA, Galloway JC. Enhanced handling and positioning in early infancy advances development through the first year. Child Development, 83(4), 1290-1302. 5. Pin, T, Eldridge B, Galea MP(2007). A review of the effects of sleep position, play position, and equipment use on motor development in infants. Developmental Medicine and Child Neurology , 49(11), 858-867. 6. Dudek-Shriber, L, Zelazny, S. (2007). The effects of prone positioning on the quality and acquisition of developmental milestones in four month old infants. Pediatric Physical Therapy . 19(1): 48-55. 7. Coulter, C, Lima, D. Tummy time tools; activities to help you position, carry, hold and play with your baby. Children’s Healthcare of Atlanta.