Using therapy time wisely

Helping Zuki to create an enriched environment for Elethu

Elethu is a alert and friendly 6 weeks old (corrected age) little boy. He was born preterm at 32 weeks and spent 5 weeks in the NICU.

Elethu's mother Zuki has brought him to the early intervention clinic for his 6 weeks developmental check up.

Therapy and formal assessment 

What Elethu's HNNE score tells 

We started by completing an HNNE. Elethu scored within the optimal range for his age  on the Hammersmith Newborn Neurological Examination. The HNNE gives an overview of his general neurological status and an optimal score indicates that the risk of developmental delay is  low.  

However, long term outcome studies of preterm infants with good neurological profiles show that they are often late in reaching the sitting, standing and walking milestones. Long term outcome studies have also found that these infants are at risk of delayed development of attention, fine motor and language abilities.

There is a growing awareness that the first two years is a period of rapid brain development and an opportunity to promote optimal motor, social,attention, and communication development to compensate for the adverse circumstances associated with very early birth.

Therapy as exploration 

So this visit is an opportunity to spend time with Elethu and his mom to explore the different ways to provide him with an enriched environment to promote his engagement with, and exploration of, the social and physical environment.

Tummy time  

Zuki has no concerns about Elethu's development but does have a question about tummy time. On her last visit to the baby clinic the sister had told her that Elethu should spend at least 20 minutes twice  day flat on the bed on his tummy. But Elethu does not like lying on his tummy, cries a lot and has learned to roll himself back onto his back.

I give Zuki a pamphlet demonstrating the different ways for a baby to lie to lie face down and start lifting up his head and trunk, and supporting on his arms. Zuki tries out some of the positions and discovers that  Elethu likes lying on his tummy with a rolled up towel under his chest. 

Encouraging reaching 

Elethu, like many babies who are born early, also tends to lie with the arms out sideways. He is slow to swipe at or reach towards toys that are dangled within easy reach.

I show Zuki how to place a rolled up towel or soft baby blanket under his head and shoulders so that the arms are lifted a little.

supine head rotation.jpg         Doll head support with roll.JPG

Zuki dangles a string of bright beads a short distance from Elethu's hand. He looks at it with great interest. After a while he swipes his arm so that it nearly touches the toy. Two more swipes and he knocks the beads. He gets very excited and kicks and smiles when he succeeds. .

I give Zuki another pamphlet with ideas of different ways to to encourage Elethu to use his hands for exploration and grasping over the next 8 weeks. 

I also notice that Elethu does not kick his legs very much except when he gets excited. Kicking is good for strengthening the leg and trunk muscles. 

To get him to kick more I place a “noisy” pillow case under his legs and we watch how he responds. To get him moving Zuki calls his name and makes some interesting noises. He enjoys this and becomes more active, and starts to kick. He immediately notices that his kicking creates a new noise, so he kicks some more and then stops. He has discovered that he can make the noise start and stop. 

I give Zuki a small ankle bracelet with a bell to try at home.

Mother infant conversation 
Zuki is a very chatty mom and talks to her boy a lot, but does not leave time for him to respond. So with Elethu sitting on Zuki's lap, I have a little conversation with Elethu modeling how to allow time for the baby to respond by looking or nodding the head. Elethu has also started to make sounds and really takes notice when I initiate his sounds.

End of session review

Before we part we do a quick review of our session today. Zuki is very relieved to hear that her baby did well on the HNNE and was pleased to learn about different ways to play with her baby.

We make a quick written list of the different things she will try at home. We make an appointment for a Whatsapp session in 4 weeks. 

More information for TOMT subscribers 
Development supine 1-2 months 
Development in supine 3-4 months 
Foundation manual behaviour birth-5 months