cerebral palsy ( cp ) is a non - progressive neurodevelopmental disorder that includes a wide 
 spectrum of syndromes related to the early onset of posture and motor impairment1 . dysfunctional postural control and movement 
 patterns lead to limitations in participation in activities of daily living ( adl)2 . according to jeong et al.3 cp is the most common infant brain injuries 
 in south korea , representing 57.8% of brain injuries in the 09 years category . management 
 of children with cp requires various rehabilitative approaches that draw on the expertise of 
 many specialists in different disciplines . some of the current clinical therapeutic 
 interventions include traditional physical and occupational therapy , neurodevelopmental 
 treatment , the vojta method , and sensory integration to improve postural control , balance , 
 and locomotion for improved participation in adl4 . many children with cp not only exhibit neuromotor deficits but demonstrate difficulties 
 with sensory processing and praxis5 . sensory integration is a dynamic process that synthesizes , organizes and processes incoming 
 sensory information from the body and the environment in order to create purposeful and 
 goal - directed responses6 . good sensory 
 integration leads to the development of good body scheme , self - image , integration of 
 primitive reflexes , balance , postural stability , ability to motor plan , coordination of two 
 sides of the body , and eye - hand coordination7 . among the sensory systems , although it may be important to apply sensory integration treatment 
 techniques and sensory based activities for children with cerebral palsy , therapists maybe 
 reluctant to do so as the evaluation of vestibular processing can prove to be difficult9 and vestibular activities may increase 
 muscle tone in unwanted areas5 . the 
 purpose of this case report is to present the effects of vestibular stimulation on a child 
 with hypotonic cerebral palsy through the use of swings . this case was referred to this author via the child s occupational therapist who felt the 
 child would benefit from this study . inje university affiliated hospital ethics review board 
 approved this case study and informed consent was obtained from the child s mother . the subject was a 19-month - old boy with a diagnosis of hypotonic cerebral palsy ( cp ) and 
 oscillating nystagmus . he was born at 39 weeks of gestation via caesarian section and there were no 
 complications reported at birth . however his mother reported him to be a fussy baby who 
 cried often and appeared to be colicky . he started to demonstrate head 
 control at about 8 months and ability to maintain the ring - sitting position for less than 30 
 seconds using his hands to prop himself up when put in a seated position ; however he had not 
 made any further progress in gross motor skills since . at 5 months of age , he started to 
 receive therapy for developmental delays , including hospital based occupational therapy 2 
 times per week , physical therapy using the neurodevelopmental treatment ( ndt ) technique and 
 the vojta method 2 times per week , and sensory stimulation once a week . he was reported to 
 cry incessantly and was inconsolable in all of his therapy sessions from when he started 
 therapies at 5 months to his initial assessment for this case study . pre and post - intervention tests were completed by the researcher using the bayley scales of 
 infant and toddler development ii . after the pre - intervention test and during the 
 intervention phase all of the subject s other therapies were stopped to control the effect 
 of vestibular stimulation without other interventions . the subject was provided with 
 vestibular stimulation 3 times per week for 10 weeks in 1 hour sessions conducted by his 
 mother as instructed by the researcher . each session started with 30 minutes of swinging on 
 an infant swing for all 10 weeks . the vestibular stimulation protocol using different swings 
 is shown in table 1 
 table 1.vestibular stimulation protocol 
 . the subject s mental raw score was 21 with a corresponding developmental age of 1 month , 
 and his motor raw score was 40 with a corresponding developmental age of 6 months , 
 pre - intervention . the subject s mental score increased to 46 with a corresponding 
 developmental age of 4 months , and his motor score increased to 58 with a corresponding 
 developmental age of 10 months ( tables 2table 2.results of bayleyscalepre - testpost - testraw scorepercentile % raw scorepercentile % mental 2146motor4058behavior ratingorientation e111%3223%emotional r121%286%motor q151%251%additional i14total r score391%897% , 3table 3.results of bayley , developmental agepre - testpost - testmental developmental age1 month4 monthsmotor developmental age6 months10 months ) . the results show that the subject exhibited improved mental and motor skills of 3 and 4 
 months respectively which is a significant improvement at this age of development . the 
 subject was able to ring - sit for less than 30 seconds at pre - test , and was not able to 
 transition from supine or prone to sitting or from sit to pull to stand . however after 10 
 weeks of intervention he was able to walk with his hand held and independently for about 15 
 meters before losing balance , and he was able to transition from supine or prone to sit to 
 pull to stand independently . as for mental skills , the subject showed no interest in toys or 
 people and he cried throughout the entire therapy session at the beginning of this study ; 
 however once he was introduced to vestibular stimulation by swinging , he smiled , laughed and 
 started to interact with both toys and people . postural control is dependent on the integration of proprioception , vision and vestibular 
 systems of which vestibular input is particularly important10 . adequate motor performance and postural control is needed for an 
 infant or a young child to independently perform and participate in play , activities of 
 daily living and social interactions . infants diagnosed with cerebral palsy demonstrate 
 difficulties with postural control and locomotion and can miss opportunities to explore 
 their environment11 . the subject in this 
 case study was diagnosed with hypotonic cerebral palsy and demonstrated poor postural 
 control , only being able to maintain a ring - sit position using his hands to prop himself up 
 for 30 seconds . the subject was not able to explore his environment due to lack of mobility 
 and he did not use his hands at the beginning of this research . one possible explanation for 
 his incessant crying during all of his therapy sessions in the past year is that he had an 
 inefficient vestibular system . sensory integration of the vestibular system provides a 
  gravitational security  which helps with the emotional well - being5 however , due to the subject s poor integration of the 
 vestibular system , he may have been fearful of being moved during all of his therapies which 
 made him resistant and cry . when the subject was presented with intense vestibular inputs on 
 different swings , he stopped crying very quickly and responded by holding his head and trunk 
 more erect and eventually improved his postural control enough for him to walk . at the 
 beginning of this study , the subject made no attempt to move his body and spent most of his 
 waking hours lying in supine . when his mother put him in sitting position or moved him , he 
 cried and was resistant to being moved . however by the end of this research the subject 
 demonstrated improvements in movement in space and transitioning from supine or prone to 
 sitting and from sitting to pull to stand independently . the vestibular system is thought to be a primary organizer of sensory information and 
 contributes to physical and emotional security12 . this case study shows that improving the integration of the 
 vestibular system through the use of swings resulted in the improvement of the subject s 
 postural control , movement , exploration , and emotional well - being . the subject s mother 
 reported feeling anxious and helpless as she did not know how to console or interact with 
 her crying child . however once the subject had been introduced to vestibular inputs on 
 different swings , he responded almost immediately by not crying , and started to laugh out 
 aloud and babbling . both the subject and his mother appeared much more relaxed with each 
 other and able to interact with each other better as the subject decreased crying and 
 started to explore his environment . the subject s mother reported that at the beginning of 
 this study she could not take him anywhere to play as he cried the entire time when she took 
 him to playgroups and playgrounds but from about the middle of the intervention of this 
 study , he started to feel comfortable when taken to new environments . the level of subject s 
 comfort , exploration , interaction , and play had improved significantly by the end of this 
 study . this study has demonstrated that vestibular inputs through the use of swings has improved 
 the subject s postural control , movement in space , emotional well - being , interaction with 
 people and environment and participation in play . therefore therapists may wish to consider 
 providing vestibular inputs for children with hypotonic cerebral palsy in treatments to 
 facilitate postural control and emotional well - being . sensory based activities must be 
 provided by a well trained and experienced therapist as children with cerebral palsy present 
 neuromotor deficits as well as sensory issues . a limitation of this case study is that there 
 was only one subject which makes it difficult to generalize the findings to a wider 
 population . therefore , further research with larger sample sizes are needed to determine the 
 effectiveness of vestibular inputs through the use of swings on children with hypotonic 
 cerebral palsy . future studies should also look at the effectiveness of sensory integration 
 and ndt in the treatment of children with cerebral palsy .
[ purpose ] the purpose of this case report is to present the effects of vestibular 
 stimulation on a child with hypotonic cerebral palsy through the use of swings . 
 [ case 
 description ] the subject was a 19-month - old boy with a diagnosis of hypotonic cerebral 
 palsy ( cp ) and oscillating nystagmus . 
 the subject had received both physical therapy and 
 occupational therapy two times per week since he was 5 months old but showed little to no 
 improvement . 
 [ methods ] pre and post - intervention tests were completed by the researcher 
 using the bayley scales of infant and toddler development ii . the subject was provided 
 with vestibular stimulation 3 times per week for 10 weeks in 1 hour sessions conducted by 
 his mother as instructed by the researcher . during this research 
 all other therapies were 
 stopped to determine the effects of the vestibular stimulation and to exclude the effects 
 of other therapies . 
 [ results ] the subject demonstrated improvement of 4 months in motor 
 skills and of 3 months in mental skills as shown by the bayley scales of infant and 
 toddler development ii . [ conclusion ] vestibular stimulation was effective in improving 
 postural control , movement , emotional well - being , and social participation of a child with 
 hypotonic cerebral palsy .