Giving the Gift of Mobility

Typically developing children reach most motor milestones in a fairly predictable manner. By six months babies are rolling; by eight months they are creeping on all fours and sitting on their own and by ten-twelve months they are standing and getting ready to take their first steps.

During this part of the first year of life, typically developing babies are exploring their environment, interacting with their families, reaching for and grasping objects and learning how to express their needs. All these skills are developed and enhanced by movement and exploration. The ability to explore, reach, interact and solve problems depends on the baby’s ability to move from lying down to sitting up and on standing and moving through the environment within the social and cultural contexts of their everyday experiences.

Mobility & Grounded Cognition

The literature is rich with articles on the effect of movement on cognition and learning. The article “Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore” ( Lobo et al, 2013) describes the term “grounded cognition” which is the idea that cognition is created, shaped and maintained by everyday perceptual motor experiences. The ability to sit, explore objects and move all have an effect on an infant’s social interaction and language development. These routines and activities promote relationships, socialization and self-care. Cognition, language, social interaction and self-help skills are all interrelated and develop within the context of motor learning.

Babies who have developmental delays or severe physical motor impairments have little opportunity to explore, interact and reach in the way that typical babies do. They are unable to move due to motor impairments, poor postural control or visual perceptual problems. This has the effect of delaying not only their motor skill but also skills in all other areas of development. They do not have the same real-life experiences that their typical peers have to play, process and problem solve. Their motor learning is affected.

Early Movement & Cognitive Development

Targeted early intervention strategies can help provide opportunities for these children to advance their skills. By providing supported sitting and mobility devices we can give mobility to babies and toddlers so they can begin to experience what their peers are able to do on their own. This should be done often and early. If a child is not able to sit and explore by six or eight months of age, PTs need to provide the intervention strategies and suggest equipment to help them do what they cannot. It is not too early for supported standing and moving by ten-twelve months of age. Rifton’s mobile stander and Pacer gait trainer are perfect for providing mobility in the upright position.

Physical therapists can help the family incorporate these strategies into everyday activities within the context of the family’s regular routines whether at home or in the daycare setting. Children are then at eye level with their peers, seeing the world from a vertical rather than horizontal position. Positioning at play tables enable children to participate with their peers in a variety of activities including feeding and eating, sand and water play, social interaction, taking turns and fine motor tasks. Moving through space enables them to participate in exploration, problem solving, social interaction and play.

Standing & Early Mobility

In addition, a recent systematic review of the evidence for pediatric supported standing programs (Paleg et al, 2013) demonstrates the benefits of standing for the musculo-skeletal system. This review suggests possible additional benefits to the gastrointestinal and cardiopulmonary systems.

Early intervention providers, and particularly physical therapists, should promote upright positioning and movement to improve function and participation, and also as a means to promote learning in all areas of development so children are more prepared for school by age five.

References

Lobo, M.A., Harbourne, R.T., Dusing, S.C., & McCoy, S.W. (2013). Grounding early intervention: physical therapy cannot just be about motor skills anymore. PT Journal, 93, (1), 94-102. OI:10.2522/ptj.20120158 Published January 2013

Paleg G, Smith B, Glickman L. (2013) Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs. Pediatr Phys Ther, 25:232-47.