Deanna Macioce, MS, OTR/L
We often spend time focusing on the benefits of what a child is doing during an activity versus the positioning of the child. However, with just a slight change in positioning, an activity can offer a whole new realm of benefits. Conversations around prone positioning (on your tummy) are common when we are discussing the development of our infants, but this positioning can be crucial to strength and development throughout life. Placing a child on his or her tummy propped up on forearms offers a great way to improve the strength of the shoulder girdle, head and neck. It improves a child’s ability to maintain a prone extension position, which is beneficial in the overall development of the sensory system. In addition, this position provides proprioceptive input and weight bearing. So, “tummy time” isn’t just for babies…it is for everyone.
Play in the prone position does not require any extra equipment; however, it can be enhanced through the use of various items. You can grab any game, puzzle, book or coloring to do while spreading out on the floor on your tummy, and it is easy to incorporate into any daily task. Being propped up on forearms is a great way to encourage a natural stretch to the chest cavity and shoulders.
The use of equipment typically encourages working with extended arms, really addressing weight bearing through the shoulders and arms while providing some good proprioceptive input. Items such as therapy balls and bolsters are ideal to accomplish this. These positions also challenge coordination and address weight shifting as a child works to maintain position with one hand and manipulate or grab an object with the other. Activities can be placed on the floor to be completed, such as a puzzle or game, or you can have the child grab beanbags to throw at a target.
Asking children to throw items strengthens and encourages good head and neck extension while working on hand-eye coordination. Having children pick up items and then place them on a vertical surface, such as pegs into a pegboard or window clings onto a mirror, helps give their hard work purpose. Using the prone position to gather items for an activity, like Mr. Potato Head, and then completing it in the upright position challenges the visual system while giving a great deal of vestibular input with all the position changes of the head.
Suspended equipment, such as the Platform Swing and Therapy Net, can be used in the same manner while increasing the challenge to activities by providing vestibular input during the task at hand. In addition, these items allow children the ability to negotiate movement on their own, really working the shoulders, head and neck. For example, while children are suspended in a swing, you can place bowling pins at different points around them, challenging them to knock them down with their hands or feet.
Using the prone position can truly increase the challenge to the task at hand, so make sure the activity being completed is “just the right” challenge so you don’t lose the benefits of the position. In addition, know the child’s tolerance and possibly only use it for short amounts of time until it can be fully tolerated. For example, a child has to place only a few puzzle pieces before moving back to an upright position.
As we see children doing more sedentary activities, we realize they are living in an “upright” world, oftentimes not getting enough vestibular input with changes in head positioning, or natural ways to strengthen their bodies through play. So shake up that treatment activity and put them on their tummy!