Human Performance and Rehabilitation Centers, Inc.

Importance of Tummy Time

The Back to Sleep program was initiated in 1992, in order to decrease the occurrence of SIDS. Since then, there has been a decline in parents/caregivers placing their infants on their tummy.  Additionally, many do not think about tummy time for play and caregivers are generally not provided with information on recommended play positions.

As a result of less time spent on their tummies, there has been an increase in the number of infants with developmental delays, This means that infants are taking longer to develop the muscles they need to achieve developmental milestones in a timely manner, such as holding their heads upright and rolling. There has also been an increase in infants with misshapen heads, such as plagiocephaly.

Parents and caregivers need to know the importance of awake, supervised tummy time, and how they can safely incorporate it into their day to day lifestyle.

What is Tummy Time?

Tummy time is the time that an infant spends on their belly/tummy. They are not sitting up, laying on their backs or even vertically held against their parent’s/caregiver’s chest.

For tummy time to count, they need to be awake and supervised. Being awake is important, because as they move, wiggle and even get upset, they are working their muscles that are needed for development, such as rolling and crawling.

Why Do We Not Put Our Infants on Their Tummies?

  • Fear – some may feel that their infants could hurt themselves, or stop breathing.
  • The infant does not like tummy time – They cry as soon as they are put on their tummies so we avoid it.
  • Some are unsure as to when they can do tummy time, are they old enough?
  • Use of devices, such as swings, bouncy seats and jumpers to vary an infants position instead of their tummy.

Why is Tummy Time Important?

Tummy time works babies muscles that are needed for development.

Awake, tummy time play has been shown to promote gross motor skill development. It allows for strengthening of antigravity extensor muscles that are needed for motor skills, such as rolling, crawling and pulling to stand. It also allows for movement exploration, thus increasing the infant’s opportunities to learn new motor skills.

Tummy time also helps alleviate gas pain and assists with preventing misshapen heads (plagiocephaly).

When Should You Begin Tummy Time?

  • Immediately
  • A newborn baby can begin right away.
  • Always do tummy time supervised.
  • Newborns sleep most of the time, so a great way to begin tummy time, with a newborn, is having them lay on your chest.

How Long Do I Do Tummy Time For?

Recommendations on the amount of time in a day an infant should spend on their tummy varies greatly.

Studies range from a minimum recommendation of 20 minutes a day to at least 80 minutes a day for a 16 week old infant.  What is consistent is that the higher the duration of tummy time, the better development of gross motor skills.

So, recommend begin slowly, and immediately. Try to aim for at least 10 minutes a day for up to 1 month of age, then keep adding 10 minutes for each month, until your baby rolls independently. So at 6 months of age, they should be on their tummy for at least 60 minutes a day.

Also, if your infant only tolerates 30 seconds, then do 30 seconds, take a break, and repeat so that over the course of the day the time adds up.

Ideas On Doing Tummy Time At Home

  • On your chest – As long as you are laying down, this counts as tummy time. This is often calming to your baby, they can look at you, and they can feel your heart beat.
  • Over your lap/towel roll/boppy pillow – anything that helps them at first to tolerate it longer, then progress to only a firm, flat surface.
  • Mirror – babies love mirrors. Can use a mirror to improve visual attention. Babies love to look at themselves.
  • Get on the floor with them – smile at them, make sounds, sing to them…. Have siblings entertain them….
  • Use toys for visual stimulation/interest
  • Rub their backs/legs/arms while they are on their tummies – this feels good and is not only calming, but also activates the muscles.

YOU CAN DO THIS! Tummy time is a great time to interact with your baby, bond with them and just have fun! Tummy time should be done when your baby is awake and always while supervised. You can keep track of tummy time with a simple chart to make it easier to keep track of and less stressful.

Catherine Stubbs, PT, DPT, PCS is a licensed Physical Therapist and Department Director at Pediatric Rehabilitation, Columbus, GA. She has been employed with HPRC since 2002. Catherine received her M.S. in Physical Therapy in 2000 from North Georgia College and State University and her DPT in 2019 from Arcadia University. She is an APTA board certified clinical specialist in pediatric physical therapy. Catherine lives with her husband, Brian, and children in Columbus, Georgia.


Take Advantage of Physical Therapy in a Fitness Facility Setting

Working out can bring big rewards, but as you get older, it’s important to also guard against injury. Taking advantage of a fitness facility’s in-house physical therapy clinic is a smart way to integrate injury prevention into your routine, and to get back to normal if you’ve experienced a setback. HPRC’s partnership with the Forest Drive location of MÜV Fitness in Columbia, South Carolina began in 2016, and it’s a great example of how gyms and clinics can combine forces to keep you active and injury free.

With 73 million individuals in the Baby Boomer generation, there’s already a high demand for physical therapists to support patients with workout-related overuse injuries as well as everyday conditions that impact us all as we age. Direct Access laws, which vary from state to state, have made it easier for patients to go straight to a physical therapist without having to see a physician first. Whether you’re experiencing a sore shoulder or knee, a stiff back or a tightness in the hip, a physical therapist can immediately evaluate the condition, determine its source and cause, and begin a therapy plan to restore function. This saves you time and money and returns you to normal activities faster.

When your physical therapist is located within a gym setting, there are even more benefits:

Immediate access leads to faster results

If you’re working out and you start to feel pain or diminishing function, you can immediately access an onsite physical therapist. At HPRC’s MÜV location in Columbia, we begin providing a complimentary screening to assess your condition. This helps you make an informed decision about pursuing therapy.

Assistance with pain control

Having access to an onsite physical therapist in a gym can also help you learn to better manage pain. A physical therapist can help you find the source of your pain and create a non-pharmacological plan for reducing and managing it.

Addressing onsite injuries fast

If you experience an injury while working out, you don’t have to wait to see a physician. You can go straight to a physical therapy clinic. The kinds of musculoskeletal conditions that people experience while exercising are the kinds of issues physical therapists see and treat every day.

Learning proper form

As you get back to full mobility after an injury, understanding your body mechanics is imperative. Your physical therapist can show you exactly how to position your body as you pursue different physical activities to empower you to prevent future injuries. In addition, your physical therapist can communicate with a personal trainer at the gym to develop a personalized program that keeps you safe and strong.


Dunny Dunlap, PT, ATC, is a licensed physical therapist employed with HPRC since 1987. He is Director of HPRC Physical Therapy in Columbia and Lexington, South Carolina. His education includes: Winthrop University, MBA 2001; Medical University of South Carolina, B.S. in PT 1987; The Citadel, M.Ed. in 1984 and B.S. in 1980. Dunny is certified in Dry Needling, Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA). He is also a Certified Athletic Trainer and his specialties and interests include orthopedics and sports injuries. Memberships include: APTA (American Physical Therapy Association); PPS (Private Practice Section of APTA); SPTS (Sports Physical Therapy Section of APTA); NATA(National Athletic Trainers Association); SCATA (South Carolina Athletic Trainers Association).

3 Ways Physical Therapists Help People with Down Syndrome

Down Syndrome: What is it?

Down Syndrome is a common genetic disorder in which a person has an extra chromosome. This extra chromosome affects how a baby is formed in Utero and produces a wide array of physical delays throughout childhood development.

What does it look like?

Some of the physical impairments commonly seen with Down Syndrome Include:

  • Hypotonia: Low muscle tone causing weakness
  • Joint Laxity: Loose joints causing increased risk of dislocation
  • Poor Balance
  • Poor Coordination
  • Delay in Gross Motor Milestone Development: Research shows that children with Down Syndrome will reach their motor milestones at a later age. For example, 78% of children will sit independently at 18 months, and 92% of children will walk at 36 months.

How Can Physical Therapy Help People with Down Syndrome?

Physical Therapists are trained to help children with Down Syndrome by improving their strength, balance and coordination, and through these improvements achieve motor milestones.

Strengthening: Physical Therapists can implement an early intervention strengthening program beginning at birth. The focus of PT will be to begin to improve neck and trunk strength in order to improve head control and help children learn to hold their head up, roll over, and sit independently. As time and age develop, goals will change to improve the strength and motor control to crawl, pull up, cruise along surfaces, and walk independently.

Balance and Coordination: As important as it is for kids to be strong enough to meet their milestones, it is equally important that they have the balance and coordination to execute the movements. Physical Therapist can begin to train a child’s balance and coordination at an early age by encouraging them to reach for toys, turn to look at things, and sitting and standing on unsteady surfaces to further challenge their balance reactions.

Promote Milestone Achievement: Improving strength and coordination in children with Down Syndrome will be the first step in promoting milestone achievement. Physical Therapists also promote further milestone achievement by implementing practice with jumping, running, skipping, stair climbing, ball skills, and more.

Physical Therapists are able to look at movement as a whole and break it down to identify where the movement impairments exist. By identifying the impairments, PT can set and address movement goals that will help children with Down Syndrome meet milestones to be able to participate in daily activities, sports, and anything else they set their minds to!

Learn more about the PT behind this article, Shelbi Moxley, PT

Chest Physical Therapy: A Help For Respiratory Distress

What is Chest Physical Therapy(CPT)?

     Chest Physical Therapy is a term used for a group of treatments used to improve respiratory efficiency, improve lung expansion, increase strength of the respiratory musculature, and reduce secretions in the lungs.  The secretions may be present in the lungs due to Viral / Bacterial Infectious Pneumonia, Cystic fibrosis, Muscular Dystrophy, Asthma, COPD, and multiple other immunodeficiency disorders. The treatments stated in this content piece may be helpful to all those in respiratory distress from lung secretions despite the etiology. Respiratory therapists, nurses, and trained family members are also able to implement these treatments to promote a continuum of care of affected individuals in multiple settings.

The treatments included within the scope of Chest Physical Therapy include the following:  postural drainage, chest percussion, chest vibration, deep breathing, and coughingPostural drainage involves sustained body positioning to allow gravity to assist drainage of the 5 lobes of the lungs.  With each position there are sections of both lungs facing downwards to promote mucus movement into the larger airways.  At this point the mucus can be huffed, or coughed, out of the airway or suctioned mechanically.  Chest Percussion, or hand clapping performed against the rib/lung field areas with a cupped hand, is a treatment used to facilitate movement of mucus from lung surfaces into the larger airways for removal.  Chest Vibration is a manual, or mechanical treatment, that is also used to promote mucus movement from the lungs.  It involves flat-hand placement over the affected lung lobe and a fine muscular tremoring of the shoulder/arm regions to shake the mucus loose.  Percussion and vibration are frequently used with the various postural drainage positions to promote the greatest dislodging of mucus from lung surfaces to improve quality of respirations.  Deep Breathing is performed to improve lung expansion and distribution of air into all of the lobes of the lung.  Coughing is used to bring the mucus out of the larger airways to eventually be spit out or suctioned from the mouth.

Precautions and Contraindications for CPT

     Adults or children with the following conditions should NOT receive CPT:

        *bleeding into the lungs                  *pulmonary embolism

*head or neck injuries                      *active hemorrhages

*fractured ribs/OI                             *open wounds/burns

*collapsed lungs                                *acute asthma

How do I perform CPT?

Find a place that is quiet and comfortable for both administrator and receiver of the treatment.  Plan the 20-40 minute treatment time prior to meals,  or 1.5 hours after a meal,  to avoid nausea, acid-reflux, vomiting, and possible aspiration from the vomiting.  Typically treatments are performed in morning and evening but frequency and duration are reliant on the physical condition of the recipient.  When working with children,  schedule the session around a favorite TV show, add a toy, or perform with favorite music on for a helpful distraction.  Comfortable clothing should be worn by the recipient of the treatment to protect the skin from the contact that will be made and jewelry/watches are not be worn by the caregiver to avoid abrasion.

  1. Choose a postural drainage position.  Use pillows, wedges, beanbags, ottomans, chairs, and other furniture to achieve desired angles as long as both parties are comfortable and breathing is not impeded.
  2. Perform percussion to region marked on postural drainage picture with cupped. The movements should be consistent and rhythmical presenting with a “hollow” sound due to the cupped position.  If you hear a “slapping” sound you are performing the technique incorrectly.  Perform the percussion for 3-5 minutes and follow-up with vibration and deep breathing/coughing (described in lower sections).  Percussion is not to be performed directly over the sternum, spine, stomach, or lowest ribs/back  to protect organs beneath those regions.
  3. Vibration is performed using both hands, in a firm, flat contour against the treated area, for 15-20 seconds or approximately 5 exhalations.  One hand is placed on top of the other hand while the arm/shoulder are creating a contraction that provides the fine vibrating movements.  The person receiving the treatment should be exhaling slowly while the vibration is present to facilitate mucus movement.
  4. Deep breathing and coughing follow the manual techniques of using the diaphragm to expand the belly during inhaling is promoted and a shrinking of the abdomen during slow exhaling is expected.  This technique promotes movement of the mucus and a spontaneous cough reflex in the recipient to expel it from the airway as well as promoting full lung expansion. Keep a trashcan, emesis container, or tissue handy for secretions to go into during coughing activity.

Chest Physical therapy is a way to help those in mild to moderate respiratory distress.  This may be a treatment given for the occasional family member that has a single bout of pneumonia or a consistent regimen that is used for a person with a chronic respiratory disease like Cystic Fibrosis or COPD. Talk with your HPRC physical therapist to find out more about how Chest Physical Therapy may help you or your family member.

Call Today To Request An Appointment With A Therapist At HPRC Auburn. Learn more about the author of this article, Karen Lynn, PT



Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. Web site:

WEB SITES “Chest Physical Therapy.” Dr. Joseph F. Smith Medical Library , 2003. Available online at (accessed December 8, 2004)

5 Self Regulation Tips to Reduce Schoolwork Battles

In a time filled with so much uncertainty, we as adults are beginning to feel overwhelmed and out of control. It is important to remember that our children feel these emotions too and need our help in dealing with them. In a short period of time, everything about their daily routine has changed. It is normal to see some frustration erupt when it comes to sitting down and doing their schoolwork. Below are 5 self regulation tips to reduce schoolwork battles while you navigate school from home. We hope they help you and your little one!

Follow a Schedule

Your child is used to having a set schedule at school where they do table work, play outside and eat lunch all at certain times. Following a similar schedule or routine at home can help them adjust better and feel some normalcy in their day. Maybe you do schoolwork in the morning then take a walk or play outside before lunch and pick up with schoolwork in the afternoon. Depending on their age let them be involved in creating the schedule. Have the schedule hanging up where they can see it and mark items off as you go to show they have been completed. If your child is younger, use a picture schedule. Knowing what activity is coming next and what to expect gives your child a sense of control over their day.

Heavy Work

Activities that target the proprioceptive sense are referred to as “heavy work.” Receptors for this sense are located in the muscle and joints and are stimulated through activities that cause pressure or use arms and legs to push/pull, lift, hang and jump. Participation in heavy work has shown to improve attention and regulate arousal level. Having your child do heavy work right before sitting down for schoolwork (or taking breaks during) can be beneficial for learning and focus. Some ideas for heavy work activities are listed below!

  • Animal Walks (crab crawl, bear crawl, bunny hops)
  • Wall Pushups
  • Roll an exercise ball or weighted ball over their body
  • Hang from Monkey Bars or climb on playground equipment
  • Push/Pull a heavy box or laundry basket

Have a clear Start and End point

If you schedule 30 minutes of schoolwork after breakfast, have a clear start and end time for your child. For older children, you can simply say “We will do your schoolwork from 9:00-9:30” and have a clock visible. For younger children, a visual timer with light and/or sound cues can be helpful such as the one linked here. Knowing when the task will end and how much time is left can help your child focus and stay on task. Be careful not to schedule too much time for one schoolwork session. If you find your child getting frustrated and distracted after 15 minutes, schedule a break after 15 minutes for the following day.  The goal is for your child to be successful in that period of time.

Give Choices

Just like adults, children get upset and frustrated when they feel out of control. Giving your child some choices allows them some sense of control over their day.  However, too many choices at once can be overwhelming.   For young children, offer 2 specific choices, both of which have been approved by you.  Language like “this or that” is a good way to present the choices. Some examples for applying this to school work are listed below:

  • Would you like to read this book or that book?
  • Do you want to use the red pencil or the blue pencil to draw shapes?
  • Would you like to write about planes or dinosaurs?
  • Would you like to sit at the table or the counter to do your work today?
  • Do you want to try 2 or 3 math problems today?

Introduce Coping Strategies

Identifying emotions and knowing how to cope with them is not an easy task for your little one. Self regulation is something that is learned over time, and your child needs your help in knowing what works and what doesn’t. When you see your child getting frustrated or upset during schoolwork, help them identify the emotion they are feeling and offer a coping strategy to try. For example, “I see you are getting frustrated while doing your math work, why don’t you take some deep breaths and drink some water and we will start again in 2 minutes.” By offering different coping strategies each time, you and your child will begin to see what works for them. What works for one child won’t necessarily work for another. Some examples of coping strategies for children are listed below.

  • Find a quiet place to be alone
  • Blow bubbles (Deep breathing)
  • Listen to music
  • Name the emotion you are feeling
  • Drink water
  • Draw a picture
  • Bear hugs
  • Exercise
  • Yoga cards
  • Squeeze a ball as hard as you can
  • Go outside
  • Run around the room 3 times
  • Count to 10

Learn more about the Pediatric Occupational Therapist behind this article, Kelsey Sharp, OT.