An Investigation of the Influence of a Wakeful Prone and Vestibular Activity Program on Early Infancy Motor Development

Critical elements of early infant motor development can be observed when very young babies spontaneously kick and wave their arms. This initial movement phase progresses through various motor milestones from engaging the inhibition of the primitive reflexes through to rudimentary movements, fundamental motor skills, and finally to engaging in specialised sports activities in the early primary school age years (Gabbard, 2012; Goodway, Ozmun, & Gallahue, 2019). Even though infants have the propensity to naturally move through these rudimentary motor milestones, time spent in awake prone positions is central to achieving to achieving these skills (Ohman, Nilsson, Lagerkvist, & Beckung, 2009). Prone positioning is commonly referred to as tummy time, which has been described as a practice whereby an infant is placed on their stomach during awake play times (Hewitt, Stanley, & Okely, 2017). This tummy time positioning encourages head, neck and arm strength supporting timely rudimentary rolling and crawling skills (Dudek-Shriber & Zelazny, 2007; Jennings, Sarbaugh, & Payne, 2009; Lobo & Galloway, 2012; Majnemer & Snider, 2005), and also reducing the risk of deformational plagiocephaly or flat head syndrome (Kennedy, Majnemer, Farmer, Barr, & Platt, 2009). Researchers have proposed that motor development and motor milestones in infants may be affected or in some cases delayed, following the introduction of sleeping babies on their backs as a result of the SIDS (Sudden Infant Death Syndrome) campaign of the 1990s (Davis, Moon, Sachs, & Ottolini, 1998; Speltz et al., 2010). As a consequence of this campaign the incidence of SIDs declined worldwide in the following years although it was reported that parents tended to avoid placing their infants on their stomach during awake times, subsequently affecting motor milestones, head shape and core strength (Davis et al., 1998; Robertson, 2011). This doctoral research centres on the Baby Activity Chart-Program (BAC-Program) that was devised and created to support families and to provide a variety of fun, tummy time and vestibular focused actions for infants from 6 weeks post birth. Families are encouraged to interact with BAC-Program’s four milestone focused divisions of 34 activities, and culminating when the infant is mobile, feasibly crawling on hands and knees. The doctoral research incorporated the concept and activities within the BAC- Program, and subsequently undertook two separate but inter-linked research studies. Study one involves the evaluation of the BAC-Program through an ‘experts’ response questionnaire’ (ERQ) presented to sixteen experts in the early childhood and the allied health professions. The questionnaire consisted of five sections covering all aspects of the BAC Program’s design, layout, diagrams, text and contents. The Experts were instructed to rate all milestone divisions within the BAC-Program within the questionnaire’s five sections and to also include comments and suggestions according to each expert’s professional expertise. Overall, this first study produced a very positive result with the BAC-Program being effectively recommended by 93% of the experts. Consequently, a BAC-Program/2 (BAC- P/2) was created as the Expert’s recommendations were carefully analysed and those considered significant and theory based to enhance the activities were incorporated into the newly produced infant activity program-edition two. The positive endorsement and results achieved in Study one enabled the newly created BAC-P/2 to be investigated in a further study within this doctoral research. Study two investigated whether an experimental group of twenty nine infants that commenced participation in the BAC-Program/2 at 10 weeks of age, were more advanced in their motor skills (prone, supine, sitting, standing) when compared to a control group of thirty four infants also observed at 7-9 months post birth. The control group had not participated in the BAC-P/2 but were presented with the program at the completion of the testing procedure. The overall results defined that the total percentage mean score on the Alberta Infant Motor Scale (AIMS) of the experimental group was significantly higher (the difference was significant at .023 alpha level) than the control group’s mean score based on all sixty three infant’s AIMS’ motor development scores. The interpretation at a practical level suggests that the participation by parents and carers in the activities within the BAC-P/2 have contributed to the overall differences in the recorded scores when comparing the means between the sample groups using the SPSS independent sample t-test. Study two also examined the differences in overall motor development between groups in relation to time spent daily in tummy time and in vestibular stimulating activities. The experimental group spent greater time daily in both activity categories (tummy time and vestibular) and recorded a higher total percentage mean AIMS score when compared to the control group, however, the differences were not statistically significant. The data revealed that the association between the two study group’s AIMS scores may be influenced by the varying amount of both daily tummy time and daily vestibular time. Interestingly, both study groups reported higher total mean percentage scores in relation to greater amounts of time spent in both tummy time and vestibular activities. The overall conclusion to this study was reinforced by the result that when participating in the BAC-Program/2 from 10 weeks to 7-9 months, involving specifically modified infant movement activities, the twenty nine experimental group infants were significantly advanced in their motor development. There are also recognisable benefits (e.g. improved head control, core strength, response to gravity, spatial and body awareness) for infants to spend significant time in tummy and vestibular focused movements in regard to achieving their motor milestones.

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