Stimulating the Motor Development of Very Premature Infants: Effects of Early Crawling Training on a Mini-Skateboard

Abstract

AbstractAimTo examine the effects of an early home-based 8-week crawling intervention performed by trained therapists on the motor and general development of very premature infants during the first year of life.MethodsAt term-equivalent age, immediately following discharge from the Neonatal Intensive Care Unit (NICU), we randomly allocated 44 premature infants born before 32 weeks’ gestation without major brain damage to one of three conditions in our intervention study: crawling on a mini-skateboard, the Crawliskate (Crawli), prone positioning control (Mattress), or standard care (Control). The Crawli and Mattress groups received 5 min daily at-home training administered by trained therapists for 8 consecutive weeks upon discharge from the NICU. The outcomes of greatest interest included gross motor development (Bayley-III) at 2, 6, 9, and 12 months (primary outcome) corrected age (CA), mature crawling at 9 months CA and general development at 9 and 12 months CA [Ages and Stages Questionnaires-3 (ASQ-3)].ResultsA 3 (Condition) x 4 (Age) repeated measures ANOVA revealed that Crawli group infants had significantly higher Bayley-III gross motor development scores than Mattress and Control group infants. Crawli group infants also scored significantly higher on groups of Bayley-III items related to specific motor skills than infants in the other groups, including crawling at 9 months CA (p<0.05). Separate one-way ANOVAs at each of the four ages tested revealed the Crawli group had significantly higher gross motor development scores than the Mattress group (p<.001) but not the Control group (p<.08) at 2 months CA, than the Mattress and Control groups at 6 months CA (p<.05), and than the Control group at 9 and 12 months CA (p<.05). The Mattress and Control groups did not differ significantly at any age. A 3 (Condition) x 2 (Age) repeated measures ANOVA revealed that the Crawli group scored significantly higher than the Control group for the ASQ-3 total score (p<.01) and communication score (p<.05) and significantly higher for the fine motor score than the Control (p<.01) and Mattress (p<.05) groups. We found additional significant differences in favor of the Crawli group for other dimensions of the ASQ-3 in separate one-way ANOVAs at 9 and 12 months CA.InterpretationEarly crawling training on a Crawliskate provides an effective way to promote motor and general development in very premature infants. The Crawli group’s significantly higher scores on the crawling items at 9 months CA provide clear evidence for a link between newborn crawling and more mature crawling later in development.What this paper addsVery premature infants can propel themselves on a mini-skateboard using crawling movements at term equivalent ageEight weeks of daily, at-home early crawling training immediately following discharge from the NICU facilitates the acquisition of mature crawling in premature infantsEight weeks of early crawling training positively influences motor development in premature infantsEight weeks of early crawling training positively influences general development in premature infantsEarly daily at-home crawling is a promising intervention for premature infants at heightened risk for motor delays and disabilities, potentially feasible for parents to conductData sharing statementThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.