A Clinical Trial Based on Reward Contingency to Improve Prone Tolerance and Motor Development is Feasible in 3- to 6-Month-Old Infants

in Journal of Motor Learning and Development
View More View Less
  • 1 Ohio State University
  • 2 University of Southern California
  • 3 Virginia Commonwealth University
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $42.00

1 year online subscription

USD  $56.00

Student 2 year online subscription

USD  $80.00

2 year online subscription

USD  $107.00

Aims: The American Academy of Pediatrics recommends “parents to incorporate supervised, awake ‘prone play’ in their infant’s routine to support motor development and minimize the risk of plagiocephaly”. The purpose of this feasibility study was to compare usual care to a reward contingency–based intervention, developed to increase prone tolerance and improve motor skills. Methods: Ten full-term infants, 3–6- months old, with poor prone tolerance were randomized to either the Education group or Reward contingency group. Each group participated in three parent education sessions and 15 intervention sessions, over the period of three weeks. Infants in the Reward contingency group used the Prone Play Activity Center, a technology developed to reinforce motor behavior of infants in prone position. Intervention frequency and parent feedback data determined the feasibility of the interventions. Results: Infants in the Reward contingency group practiced a median of 12 of the 15 anticipated intervention sessions in the Prone Play Activity Center. These infants used the device for a mean of 18 minutes per day. Parents of infants in the Education group practiced a median of 10 sessions of the 15 anticipated intervention sessions. Conclusion: The reward contingency–based intervention is feasible for use in a future clinical trial with some modifications.

Tripathi is with the Pediatric and Rehabilitation Laboratory, Ohio State University, Columbus, OH, USA. Dusing is with the Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA. Pidcoe, Shall, and Riddle are with the Department of Physical Therapy; Xu is with the Department of Counselling and Special Education; Virginia Commonwealth University, Richmond, VA, USA.

Tripathi (Tanya.Tripathi@osumc.edu) is corresponding author.

Supplementary Materials

    • Supplementary Material 1 (pdf 214 KB)
    • Supplementary Material 2 (pdf 387 KB)
  • Back to sleep, tummy to play. (2017, January 20). Retrieved from https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx

    • PubMed
    • Export Citation
  • Bartlett, D.J., & Fanning, J.E.K. (2003). Relationships of equipment use and play positions to motor development at eight months corrected age of infants born preterm. Pediatric Physical Therapy, 15(1), 815. PubMed ID: 17057426 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brazelton, T.B., & Nugent, J.K. (1995). Neonatal behavioral assessment scale (3rd ed.). London, UK: Mac Keith Press.

  • Chizawsky, L.L., & Scott‐Findlay, S. (2005). Tummy Time!. Nursing for Women’s Health, 9(5), 382387. PubMed ID: 32449377

  • Collett, B., Breiger, D., King, D., Cunningham, M., & Speltz, M. (2005). Neurodevelopmental implications of “deformational” plagiocephaly. Journal of Developmental Behavioral Pediatrics, 26(5), 379389. PubMed ID: 16222180 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Darrah, J., Bartlett, D., Maguire, T.O., Avison, W.R., & Lacaze-Masmonteil, T. (2014). Have infant gross motor abilities changed in 20 years? A re‐evaluation of the Alberta Infant Motor Scale normative values. Developmental Medicine & Child Neurology, 56(9), 877881. PubMed ID: 24684556 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dudek-Shriber, L., & Zelazny, S. (2007). The effects of prone positioning on the quality and acquisition of developmental milestones in four-month-old infants. Pediatric Physical Therapy, 19(1), 4855. PubMed ID: 17304097 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dunst, C.J., Trivette, C.M., Raab, M., & Masiello, T.L. (2008). Early child contingency learning and detection: Research evidence and implications for practice. Exceptionality, 16(1), 417. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dusing, S.C., Harbourne, R.T., Lobo, M.A., Westcott-McCoy, S., Bovaird, J.A., Kane, A.E., … Brown, S.E. (2019). A physical therapy intervention to advance cognitive and motor skills: A single subject study of a young child with cerebral palsy. Pediatric Physical Therapy, 31(4), 347352. PubMed ID: 31568380 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dusing, S.C., Tripathi, T., Marcinowski, E.C., Thacker, L.R., Brown, L.F., & Hendricks-Muñoz, K.D. (2018). Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: A pilot randomized controlled trial. BMC Pediatrics, 18(1), 46. PubMed ID: 29426320 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eldridge, S.M., Chan, C.L., Campbell, M.J., Bond, C.M., Hopewell, S., Thabane, L., & Lancaster, G.A. (2016). CONSORT 2010 statement: Extension to randomised pilot and feasibility trials. Pilot and Feasibility Studies, 2(1), 64. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Enright, M.K., Rovee-Collier, C.K., Fagen, J.W., & Caniglia, K. (1983). The effects of distributed training on retention of operant conditioning in human infants. Journal of Experimental Child Psychology, 36(2), 209225. PubMed ID: 6631328 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gerhardstein, P., Kraebel, K., & Tse, J. (2006). Using operant techniques with humans infants. The Behavior Analyst Today, 7(1), 5669. doi:

  • Griffith, H., & Biswas, S. (2017, July). Home-based upper extremity rehabilitation support using a contactless ultrasonic sensor. In 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (pp. 853856). IEEE.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Harbourne, R.T., Dusing, S.C., Lobo, M.A., Westcott-McCoy, S., Bovaird, J., Sheridan, S., … Marcinowski, E.C. (2018). Sitting together and reaching to play (START-play): Protocol for a multisite randomized controlled efficacy trial on intervention for infants with Neuromotor disorders. Physical Therapy, 98(6), 494502. PubMed ID: 29767802 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Heathcock, J.C., Bhat, A.N., Lobo, M.A., & Galloway, J. (2004). The performance of infants born preterm and full-term in the mobile paradigm: Learning and memory. Physical Therapy, 84(9), 808821. PubMed ID: 15330694 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hewitt, L., Stanley, R.M., & Okely, A.D. (2017). Correlates of tummy time in infants aged 0–12 months old: A systematic review. Infant Behavior and Development, 49, 310321. PubMed ID: 29096238 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hunter, J.G., & Malloy, M.H. (2002). Effect of sleep and play positions on infant development: Reconciling developmental concerns with SIDS prevention. Newborn and Infant Nursing Reviews, 2(1), 916. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Klimo, P., Jr., Lingo, P.R., Baird, L.C., Bauer, D.F., Beier, A., Durham, S., … Tamber, M.S. (2016). Congress of Neurological Surgeons systematic review and evidence-based guideline on the management of patients with positional plagiocephaly: The role of repositioning. Neurosurgery, 79(5), E627E629.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Koo, T.K., & Li, M.Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155163. PubMed ID: 27330520 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Koren, A., Reece, S.M., Kahn-D’angelo, L., & Medeiros, D. (2010). Parental information and behaviors and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care, 24(4), 222230. PubMed ID: 20620848 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Morgan, C., Darrah, J., Gordon, A.M., Harbourne, R., Spittle, A., Johnson, R., & Fetters, L. (2016). Effectiveness of motor interventions in infants with cerebral palsy: A systematic review. Developmental Medicine & Child Neurology, 58(9), 900909. PubMed ID: 27027732 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Novak, I., Mcintyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., … Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: State of the evidence. Developmental Medicine & Child Neurology, 55(10), 885910. PubMed ID: 23962350 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Piper, M.C., Pinnell, L.E., Darrah, J., Maguire, T., & Byrne, P.J. (1992). Construction and validation of the Alberta Infant Motor Scale (AIMS). Canadian Journal of Public Health, 83(Suppl. 2), S46S50. PubMed ID: 1468050

    • Search Google Scholar
    • Export Citation
  • Rovee-Collier, C.K., & Gekoski, M.J. (1979). The economics of infancy: A review of conjugate reinforcement. Advances in Child Development and Behavior, 13, 195255. PubMed ID: 484323

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Russell, D., Rosenbaum, P., Wright, M., & Avery, L.M. (2013). Gross motor function measure (GMFM-66 & GMFM-88) user’s manual (2nd ed.). London, UK: Mac Keith Press.

    • Search Google Scholar
    • Export Citation
  • Sargent, B., Reimann, H., Kubo, M., & Fetters, L. (2015). Quantifying learning in young infants: Tracking leg actions during a discovery-learning task. Journal of Visualized Experiments, (100), e52841. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Scott, T.M. (2001). A schoolwide example of positive behavioral support. Journal of Positive Behavior Interventions, 3(2), 8894.

  • Thelen, E. (1995). Motor development: A new synthesis. American Psychologist, 50(2), 7995. PubMed ID: 7879990 doi:

  • Thorne, S., & Kamps, D. (2008). The effects of a group contingency intervention on academic engagement and problem behavior of at-risk students. Behavior Analysis in Practice, 1(2), 1218.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tripathi, T., Dusing, S., Pidcoe, P.E., Xu, Y., Shall, M.S., & Riddle, D.L. (2019). A motor learning paradigm combining technology and associative learning to assess prone motor learning in infants. Physical Therapy, 99(6), 807816. PubMed ID: 31155666 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Van Vlimmeren, L.A., van der Graaf, Y., Boere-Boonekamp, M.M., L’Hoir, M.P., Helders, P.J., & Engelbert, R.H. (2007). Risk factors for deformational plagiocephaly at birth and at 7 weeks of age: A prospective cohort study. Pediatrics, 119(2), e408e418. PubMed ID: 17272603 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vygotsky, L.S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.

  • Zachry, A.H., & Kitzmann, K.M. (2011). Caregiver awareness of prone play recommendations. American Journal of Occupational Therapy, 65(1), 101105. PubMed ID: 21309377 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 99 98 19
Full Text Views 0 0 0
PDF Downloads 0 0 0