Table 1 The exercise protocol for very young infants with CHD

Supine

Flexing and extending each hand at the wrist

5

10

50

Flexing and extending each arm at the elbow

5

10

50

Flexing and extending each arm at the shoulder

5

10

50

Flexing and extending each foot at the ankle

5

10

50

Flexing and extending each leg at the knee

5

10

50

Flexing and extending each leg at the hip

5

10

50

Holding the infant’s leg and directing the foot toward the toy in midline

30

2

60

Holding a stationary toy in midline within the infant’s visual field, and leading the foot toward the toy for a few seconds to allow the infant to contact the toy spontaneously. If the infant do not contact the toy spontaneously, the physiotherapist performs tactile stimulation with the toy to the infant’s foot

30

2

60

Holding an infant’s hip at 90 degrees, holding a stationary toy within the infant’s visual field, and encouraging the foot to contact the toy

30

2

60

Holding the infant’s forearm and directing the hand toward the toy in midline

30

2

60

Performing tactile stimulation with the toy on one upper limb of the infant, taking the toy to the midline, and waiting a few seconds to allow the infant to contact the toy with the hand spontaneously

30

2

60

Holding a stationary toy in the midline within the infant’s visual field, and leading the hand toward the toy for a few seconds to allow the infant to spontaneously contact the toy. If the infant does not spontaneously contact the toy, the physiotherapist performs tactile stimulation with the toy in the infant’s hand

30

2

60

Prone

Prone on a ball: use elbows to support the weight and raise the head

30

4

120

Hand reaching to contact a toy slightly out of reach

30

4

120

Side-lying

Anterior-posterior rocking: place hands on hips and on the shoulders and head; slowly rock forward and backward

6

10

60

Lower trunk rotating: placing hands between lower extremities to control pelvis; slowly rotate the pelvis on the upper trunk anteriorly and posteriorly

6

10

60

Supported-sitting

Displacing the trunk slowly in anterior, posterior, and lateral directions, 30 degrees from a vertical position. Place back upright to 20 degrees of a vertical position. Head and upper trunk supported throughout entire displacement

6

10

60

Rotating the upper body slowly to each side with the head and upper extremities supported; approximately 45 degrees of rotation

6

10

60

Supporting infant 20 degrees from a vertical position; placing index fingers on side of head to control bobbing. Briefly removing head support to encourage head control.

6

10

60