Effect of the inclination of support in cervical and upper limb development

Abstract

Introduction It is expected that a child will acquire control of posture (CP) of the head and upper limbs in a gradual, sequential and organized way. However, there is still no consensus regarding the best position to achieve this; the evidence suggests that it is prone. Objective To investigate whether age and inclination of the supporting surface in the prone position influence the alignment of the head and upper limbs of children with typical motor development (TMD) and atypical motor development (AMD). Methods The study included 29 children aged between one and three months divided according to the Alberta Infant Motor Scale (AIMS) into groups with TMD (n = 18) and AMD (n = 11). The children were placed in the prone position with three angles of the support surface (0°, 25° and 45°). Kinematic analysis was conducted to evaluate the alignment angles of the head and upper limbs. Results Children with TMD had higher head alignment. There was no difference in the upper limbs’ alignment between the group with TMD and the group with AMD. In the third month of age compared with the first, increased head alignment and decreased upper limb alignment were found in both groups. The inclination of the supporting surface did not influence the alignment of the head and upper limbs. Conclusions Among the positions evaluated, the prone position without inclination of the supporting surface was more appropriate for weight discharge in the upper limbs, favoring the development of postural control of the child.

Prone Position as a Care Practice of the Physical Therapists in Public Neonatal Intensive Care Units in Southern Brazil Prone Position in NICU Southern Brazil

“…On the other hand, aspects such as the team's lack of collaboration, either due to insecurity or resistance concerning this position, can be considered factors of interference in the decubitus alternation routine in the NICUs surveyed. When positioned in different positions, the newborns experience different pressure forces in the joints and muscles, acting positively in the development of mechanoreceptors, responsible for the coordination of movement, in order to prevent musculoskeletal deficits 14,26,29 .…”

“…Also, positioning itself is used to promote neurobehavioral and neuromotor stability 12,13 , which occurs from the alternation of newborns decubitus in NICUs5,13. The most significant opportunity for practice in the prone position is also related to infants with better development of motor and weight-bearing capacities against gravity 14,15 . Thus, this study aimed to identify the use of prone position, as per physical therapy care, for newborns admitted to an NICU in southern Brazil, aiming NPMD.…”

Aquisição do controle postural por meio de posturas altas em prematuro extremo com diagnóstico de displasia broncopulmonar grave: relato de caso

“…(33) The vestibular stimulation gained emphasis on physiotherapeutic treatment of children evaluated in this study because the stimulation against gravity may favor the gain of postural control. (14) Thus, the stimulation of sitting and standing positions, favored the gain of cervical and trunk control, as when initiated the intervention, the patient remained most of the time in the supine position. From the moment that the family were advised regarding the proposed exercises, along with the periodic exchange of decubitus, more movement was observed in both the supine and in the prone position and greater interaction with the environment.…”

“…(35) The cervical control and upper limb support are favored in the prone position, (14,36) once the required cervical stabilization in this position interferes with the organization posture of the whole body. (37) When maintained in this position, motor skills and weight support tend to develop against gravity, not only in this posture, but in others, such as supine, (38) sitting (38)(39)(40) and standing (40) .…”

“…(9) The evolution of these infants can be used for early diagnosis and intervention, because the sooner started stimulation, the greater will be the use of brain plasticity, with minor development changes and less impact on the future life of the child (10)(11)(12)(13) . Vestibular stimulation, i.e., the exchange of positions against the action of gravity favors the gain of the posture control, thus improving the overall engine development (14) . However, until the present date, no studies were found that evaluated the effect of anti-gravity positions in extremely premature infant with neuropsychomotor development delay.…”