Let's Play: a study of PTs working with infants

Håkstad, R. B., Obstfelder, A., & Kristin, G. (2017).  Let ’s play ! An observational study of primary care physical therapy with preterm infants aged 3 – 14 months. Infant Behavior and Development, 46, 115–123. Abstract

An important aspect of physical therapy for infants is the ability of the PT to socially engage the infant and motivate them to move, try out new things, persist in the face of failure and explore different ways of achieving their goals. This requires cooperation between the infant, the therapist and the caregiver. 

Using enactive and phenomenological views on cooperation, attention and intentions (Fantasia, De Jaegher, & Fasulo, 2014)  Hakstak et al (2017) investigated how PTs scaffold and use play in physical therapy interventions with preterm infants at corrected age (CA) 3–14 months. Data was collected by observing 7 physical therapy sessions with 7 different  infants born preterm, and then analyzed using enactive theory on cooperation.

The finding of this study demonstrated that “successful sensory-motor play interactions during therapy are founded on mutuality between the PT and the infant. The PTs strive to connect with and uphold the infant’s engagement, and simultaneously proceed with their targeted therapeutic actions. In this process, the PTs have to attune themselves to the infant’s signals and act in concurrence to them. They arrange the therapeutic stage, incorporate relevant therapeutic measures into play activities and adjust their strategy in accordance with the infant’s signals of initiative and interest; and on signs of disengagement and distress. Successful attunement and interaction, including repairs of interactional mismatches, facilitate prolonged training sessions and provide the infants with novel motor challenges that promote the emergence of new skills.” (Hakstad 2017)

However, the PTs’ responses were not always supportive of the infants’ engagement. "When the PTs were preoccupied by their own agenda, they were less attentive toward the infants’ engagement and sometimes disrupted the infants’ play activity. As an example we present a situation from the session with Anna, 9 months CA. While Dad and the PT have been conversing, Anna has been playing in solitude. Now, the PT wants to undress Anna before the continuation of the session:"

"Anna is laying in prone in front of a mirror, she is making low, babbling sounds and claps at her own reflection. The PT approaches her: “Are we grown-ups just talking now? And you found a girl there, did you?” The PT grabs Anna, turns her away from the mirror and pushes a squared cushion in front it. “Now it was gone, yes yes, oh well”, says the PT. Anna moans and tries to pull herself up to the cushion. The PT responds: “Yes yes, I know you understand there is someone there, but it’s gone now you know”. After terminating the mirror activity, the PT starts to pulls a toy across the floor. Anna gets interested and starts crawling toward it. Before Anna reaches the toy, the PT takes hold of her, rolls her over to supine and says: “Yes, now we’re going to try to take off some clothes”. After her bodysuit is removed, the PT again introduces the toy and entices Anna to roll into prone to fetch it. But Anna merely glances at the toy and remains passive in the supine position.” 

Implications of clinical practice

The study does not give any indication of how many of the interactions between the therapist and infant were successful. However, from the descriptions of the unresponsive interactions of two of the seven participating PT's, it would seem that it cannot be taken for granted that  PT's working with infants have the skills needed for engaging with infants in a cooperative and sensitive manner.

See also: My cooperative play skills 


Håkstad, R. B., Obstfelder, A., & Kristin, G. (2017).  Let ’s play ! An observational study of primary care physical therapy with preterm infants aged 3 – 14 months. Infant Behavior and Development, 46, 115–123. Abstract

Request a copy of this article from the corresponding author:  Ragnhild B Håkstad email ragnhild.hakstad@uit.no

Fantasia, V., De Jaegher, H., & Fasulo, A. (2014). We can work it out: an enactive look at cooperation. Frontiers in Psychology, 5, 874. http://doi.org/10.3389/fpsyg.2014.00874

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