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Stationary Activity Centers - March 24, 2002 8:57:00 AM
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Bill Egan
Posts: 52
Joined: April 22, 2001
From: Newton, MA
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Hello:
I'm an orthopedic PT, I was wondering what pediatric specialists think about using stationary activtity centers(exersaucers). I have a very active 5 month old daughter. Our friends all use these devices to entertain their babies. This does not seem like a good idea to me, given that her leg and postural muscles are not developed enough to support her in standing and using an assistive device might lead to unnatural motor patterns. I have read somewhere that walkers can delay the onset of walking in infants, but I have not read anytrhing on these activity centers. What to you all think ?
Thanks
Bill Egan
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Re: Stationary Activity Centers - March 24, 2002 3:53:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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The only advantage of exersaucers over baby walker is that because the child can't move, there is no risk of the child tipping the exersaucer, tipping it over, hitting thier head and ending up with a TBI --- or worse yet --- falling down the steps and injuring much more.
The pejuratives of putting a child in vertical before lower trunk muscles have properly developed are the same regardless of device. Kids compensate by retracting scaps, throwing thier body off balance, and ending up on thier toes. This leads to tightening of the heel cords, APT, and poor balance --- not to mention reaserch showing that kids placed in walkers too early actually walk LATER than matched peers. I'd suggest that this effect is even worse with exersaucers because, unlike baby walkers, there is no CPG stimulation benefit.
Finally, and this is perhaps the most pressing reason to keep kids out of these things, is that the opaque trays distort children's sense of body awareness. The distortion in visual reception impacts problem solving abilities and, according to research, accounts for COGNITIVE delays of roughly 20 points on standardized tests that can take up to 2 years to resolve.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 24, 2002).]
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Re: Stationary Activity Centers - March 24, 2002 7:23:00 PM
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PTstud
Posts: 86
Joined: March 8, 2002
From: Texas
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DREW, YOU ROCK MAN!!!!!!!!!!!!!!!!!!
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Re: Stationary Activity Centers - March 25, 2002 5:57:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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A point well taken. I think that the subjects in the studies I quoted were in for at least 20 minutes per day.
I'm sure that your kids are fine SJ, but could they have been 20 points smarter???? How can you assess this without a control????
Drew
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Re: Stationary Activity Centers - March 26, 2002 6:59:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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SJSJSJSJSJ,
Your statements demonstrating your understanding of research methods, and application to clinical practice, never cease to amaze me.
Besides, with all due respect, how is it that you feel comfortable and competent to comment on research that you've never read? Clinical opinion is entertaining and all, but ALWAYS trumped by randomized controlled clinical trials.
Sorry if those results bruise your ego.
Not to mention the fact that, forgoing the cognitive research for a minute, that neither of your kids are old enough to as yet be clearly in the cohort of children more likely, in their teenage years, to be experiencing preventable parental produced (by being placed in vertial too soon) low-back pain resulting from the APT and high heel pressures in standing.
Drew
P.S. The baby walker-cognition study used, I think, the Bayley II to assess cognition. That particular test has 15 or 16 point standard deviation bandwidths. Either way, it's more than a standard deviation. Children must be below a standard score (a DMQ is the same thing as the standard score, and on a Standford-Binet, is the same thing as an IQ) of 78, in two areas of development, to be considered eligible for special needs services, or under a 72 in one area. So if your kids had an IQ of 90, they would be considered "normal" --- but you don't know, you could't possibly know, if the baby walker was the difference between your child's IQ being 90, or 110 at 2 years of age --- or 120 instead of 100. Both are "within normal limits," but that's not to say that the baby walking didn't yield pejurative cognitive effects.
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 26, 2002).]
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 26, 2002).]
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Re: Stationary Activity Centers - March 27, 2002 4:49:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Siegal AC, Burton RV. Effects of baby walkers on motor and metnal development in human infants. J Dev Behab Pediatr. 1999; 20:355-361
Developmental studies suggest that visual feedback about body position and limb movement is necessary for the most efficient acquisition of motor milestones (see Betterworth G. et al. Perception. 1977;6:255-263. or Lasky RC. Child Dev. 1977; 48:112-117.). Anyway, Siegal and Burton examined the motor and mental devlopment in 109 infants (the vast majority of which were white) with and without walker experiences between the ages of 6 and 15 months. 56 had experience using walkers, and 53 had no walker experiences. The walker group was further divided into 2 groups, 34 using occluding walkers with large opaque trays, and small leg openings, and 19 who used outdated see-feet walkers that allowed for them to see their legs, thus permitting visual body awareness.
Walker-experienced infants sat, crawled, and walked later than their matched no-walker controls, and the results were statistically significant. They also scored lower on the Bayley scales of mental and motor development. The group using occluding walkers that prevented visual feedback of limb position had even lower scores. The results suggested that restriction in a walker may exert its greatest negative influence on mental development in the 6 to 9 month age period, and "the effect of walker use on mental development is not short-lived, as frequent initial use continued to predict comparatively lower mental scores for as long as 10 months after initial use.
As for the "big picture," I think you're missing the point. What difference does it make if it's the culture of the family of children placed in exersauces, or the exersaucer itself that produces the pejorative effects? Either way, it's not advisable.
APT is standard shorthand for Anterior Pelvic Tilt, and, I would think, would be far more commonly used terminology for an ortho PT such as yourself than a peds therapist like myself. I don't want to go into how poor development in early infancy relates to postural problems and pain because that's the subject of week to month long continuing education courses and would be too much to write about here. I would refer you to either a week-long NDT course, or the massive qualitative study conducted by Lois Bly (which you can read about in her book Motoer Skills Acquisiion in the First Year)
As for the high heel pressures, I'd suggest speaking to the folks at Orthostep, because they can explain the following FAR better than I can, but in short, the induced APT yields postural compensations down the chain, typically hip ER/duck walking, calcaneal inversion (NOTED ONLY IN SUBTALAR NEUTRAL --- NOT SIMPLE WEIGHT BEARING), excessive forefoot pronation, and visually looking like a high arch. When this happens, although the INITIAL compensation to the weak lower trunk may be toe walking, the body eventually compensates and high heel pressues, and a rather rigid foot result.
Drew
P.S. My initial statement WAS a compliment of sorts. Comments as such, which I'm sure aren't unique to you and you alone, facilitate teaching moments by which the entire thread benefits. On behalf of all RehabEdge members, I thank you for that!
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Re: Stationary Activity Centers - March 27, 2002 8:32:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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#1 The issue at hand in this study is the opaque tray, the results, therefore, can be generalized. This is not a leap.
#2 These other variables were taken into account, that's why quantitative reseacher is conducted in a matched and randomized way. (APGAR scores, are not predictive of future development by the way, but that's another discussion --- yes, I know, not logical results, but this has been repeatedly demonstrated).
#3 You can't argue both points SJ. Either you want the research to be conducted in an inclusive or qualitative manner, or you don't, but you can't pick and choose from moment to moment as it suits your needs. At any rate, you missed my point. Children that are placed in baby walkers don't do as well as those that weren't in terms of mental and motor outcome measures. If the external variables of parental laziness played as large a role as you'd question, then there would be no difference between kids that were "opaque trayed," and "clear trayed." So while I understand your concern, and it's a valid one, the researchers, in a way, addressed it and dismissed it to my satisfaction as the only differing variable between the two subgroups of kids in walkers, was a clear or opaque tray. How do you propose that would be linked to any of the external variable concerns that you raised? Personally, I don't think it is.
As for "when the greatest delay is during the 6-9 months and may last for up to 10 months, well, geesh, it's pretty insignificant in the scheme of life, don't you think?" I'd have to give a mixed answer on that. Afterall, the entire early intervention system is based on that very "significance" of developmental stimulation despite the fact that most studies suggest that by 8 years of age, EI doesn't make much difference as to the functioning in the child --- except perhaps in the domain of communication. So, as a pediatric PT, I'll stay the heck out of that kind of philosophical discussion in open forum if you don't mind.
Many young kids do in fact have the little protruding bellies, they may not be running on thier tippy toes, but you'll note, upon close inspection, that their heel strike isn't quite normal either. Many will completely self-resolve, and others will "shadow resolve" meaning that they will compensate well enough for most people, even compotent PT's to miss the increased potential for painful syndromes down the pike.
As for the reliablity and accuracy of the study, I'm not sure that you and I use the terms the same way. It is accurate and valid in the sense the methods used were sound research protocols to answer the research question at the level that the authors intended. The results weren't under nor over stated in my opinion. As for reliablity, that term means generalizable, not just will the results be the same upon multiple subsequent testing. It's hard to day how reliable the study is because, to my knowledge, it's not yet been replicated. As I pointed out, 102 of the 109 subjects were white, and the point you made about kids from different cultures developing in slightly different patterns is a good one. (A GREAT reference would be Cohen, et al. Evaluation of the Peabody Developmental GM scales for Young children of African American and Hispanic Ethinic Bacgrounds. Ped Phys Ther 1999;11:191-197). Anyway, the study isn't particularly reliable in the sense that the results cannot and should not be generalized from a population of white infants, to a population of african american, hispanic, or asian children.
Drew
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Re: Stationary Activity Centers - March 24, 2002 3:53:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
|
The only advantage of exersaucers over baby walker is that because the child can't move, there is no risk of the child tipping the exersaucer, tipping it over, hitting thier head and ending up with a TBI --- or worse yet --- falling down the steps and injuring much more.
The pejuratives of putting a child in vertical before lower trunk muscles have properly developed are the same regardless of device. Kids compensate by retracting scaps, throwing thier body off balance, and ending up on thier toes. This leads to tightening of the heel cords, APT, and poor balance --- not to mention reaserch showing that kids placed in walkers too early actually walk LATER than matched peers. I'd suggest that this effect is even worse with exersaucers because, unlike baby walkers, there is no CPG stimulation benefit.
Finally, and this is perhaps the most pressing reason to keep kids out of these things, is that the opaque trays distort children's sense of body awareness. The distortion in visual reception impacts problem solving abilities and, according to research, accounts for COGNITIVE delays of roughly 20 points on standardized tests that can take up to 2 years to resolve.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 24, 2002).]
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Re: Stationary Activity Centers - March 24, 2002 7:23:00 PM
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PTstud
Posts: 86
Joined: March 8, 2002
From: Texas
Status: offline
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DREW, YOU ROCK MAN!!!!!!!!!!!!!!!!!!
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Re: Stationary Activity Centers - March 25, 2002 5:57:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
|
A point well taken. I think that the subjects in the studies I quoted were in for at least 20 minutes per day.
I'm sure that your kids are fine SJ, but could they have been 20 points smarter???? How can you assess this without a control????
Drew
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Re: Stationary Activity Centers - March 26, 2002 6:59:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
|
SJSJSJSJSJ,
Your statements demonstrating your understanding of research methods, and application to clinical practice, never cease to amaze me.
Besides, with all due respect, how is it that you feel comfortable and competent to comment on research that you've never read? Clinical opinion is entertaining and all, but ALWAYS trumped by randomized controlled clinical trials.
Sorry if those results bruise your ego.
Not to mention the fact that, forgoing the cognitive research for a minute, that neither of your kids are old enough to as yet be clearly in the cohort of children more likely, in their teenage years, to be experiencing preventable parental produced (by being placed in vertial too soon) low-back pain resulting from the APT and high heel pressures in standing.
Drew
P.S. The baby walker-cognition study used, I think, the Bayley II to assess cognition. That particular test has 15 or 16 point standard deviation bandwidths. Either way, it's more than a standard deviation. Children must be below a standard score (a DMQ is the same thing as the standard score, and on a Standford-Binet, is the same thing as an IQ) of 78, in two areas of development, to be considered eligible for special needs services, or under a 72 in one area. So if your kids had an IQ of 90, they would be considered "normal" --- but you don't know, you could't possibly know, if the baby walker was the difference between your child's IQ being 90, or 110 at 2 years of age --- or 120 instead of 100. Both are "within normal limits," but that's not to say that the baby walking didn't yield pejurative cognitive effects.
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 26, 2002).]
[This message has been edited by Andrew M. Ball MS MBA PT (edited March 26, 2002).]
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Re: Stationary Activity Centers - March 27, 2002 4:49:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
|
Siegal AC, Burton RV. Effects of baby walkers on motor and metnal development in human infants. J Dev Behab Pediatr. 1999; 20:355-361
Developmental studies suggest that visual feedback about body position and limb movement is necessary for the most efficient acquisition of motor milestones (see Betterworth G. et al. Perception. 1977;6:255-263. or Lasky RC. Child Dev. 1977; 48:112-117.). Anyway, Siegal and Burton examined the motor and mental devlopment in 109 infants (the vast majority of which were white) with and without walker experiences between the ages of 6 and 15 months. 56 had experience using walkers, and 53 had no walker experiences. The walker group was further divided into 2 groups, 34 using occluding walkers with large opaque trays, and small leg openings, and 19 who used outdated see-feet walkers that allowed for them to see their legs, thus permitting visual body awareness.
Walker-experienced infants sat, crawled, and walked later than their matched no-walker controls, and the results were statistically significant. They also scored lower on the Bayley scales of mental and motor development. The group using occluding walkers that prevented visual feedback of limb position had even lower scores. The results suggested that restriction in a walker may exert its greatest negative influence on mental development in the 6 to 9 month age period, and "the effect of walker use on mental development is not short-lived, as frequent initial use continued to predict comparatively lower mental scores for as long as 10 months after initial use.
As for the "big picture," I think you're missing the point. What difference does it make if it's the culture of the family of children placed in exersauces, or the exersaucer itself that produces the pejorative effects? Either way, it's not advisable.
APT is standard shorthand for Anterior Pelvic Tilt, and, I would think, would be far more commonly used terminology for an ortho PT such as yourself than a peds therapist like myself. I don't want to go into how poor development in early infancy relates to postural problems and pain because that's the subject of week to month long continuing education courses and would be too much to write about here. I would refer you to either a week-long NDT course, or the massive qualitative study conducted by Lois Bly (which you can read about in her book Motoer Skills Acquisiion in the First Year)
As for the high heel pressures, I'd suggest speaking to the folks at Orthostep, because they can explain the following FAR better than I can, but in short, the induced APT yields postural compensations down the chain, typically hip ER/duck walking, calcaneal inversion (NOTED ONLY IN SUBTALAR NEUTRAL --- NOT SIMPLE WEIGHT BEARING), excessive forefoot pronation, and visually looking like a high arch. When this happens, although the INITIAL compensation to the weak lower trunk may be toe walking, the body eventually compensates and high heel pressues, and a rather rigid foot result.
Drew
P.S. My initial statement WAS a compliment of sorts. Comments as such, which I'm sure aren't unique to you and you alone, facilitate teaching moments by which the entire thread benefits. On behalf of all RehabEdge members, I thank you for that!
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