BARRY WILLIAMS /Special

Margi Williams plays with Zachary Amos, 1. Zachary, who has spina bifida, is using the Infant Adaptive Crawler, a device that Williams designed to help babies become independently mobile and to improve their development. The device was built by the Georgia Tech Center for Assistive Technology and Environmental Access.

Most people enter a nursing doctoral program with career goals in mind. Margi Williams, who will add a Ph.D. to her credentials this month, had a higher mission.

"For me, the degree is a wonderful byproduct for advancing my idea for the Infant Adaptive Crawler," she said. "Every paper I've written and the research I've done for this degree has been to help make this idea a reality. I believe I'm doing something that God wants me to do."

As a staff nurse in the Children's Healthcare of Atlanta comprehensive intensive rehabilitation unit, Williams works daily with children who need extensive physical and occupational therapy. But watching a healthy baby in an infant carrier in 2001 sparked her idea to help give greater mobility to babies with spina bifida and other motor disabilities.

"I remember how my own kids crawled and got into things, starting at about 6 months. I wondered how containing babies in plastic contraptions affected their normal childhood development," said Williams, MSN, CRRN, APRN-BC, FADBA.

She saw that infants with spina bifida — who had various degrees of paralysis, making it difficult for them to move, crawl or walk — were overdependent on their parents and had problems with learning later in life. The idea that wouldn't leave Williams' mind was a device to help these children become more mobile.

Innovation at work

"I could see it in my head, but my fellow students kept asking me what this adaptive crawler looked like, so I went to Wal-Mart and Home Depot," she said. "I bought a portable ironing board, some contour head pillows, some plastic sheeting, a Care Bears pillow case, some bed-sheet straps and some caster wheels to create a sort of padded skateboard. High-tech and sophisticated it was not."

But it was intriguing enough to earn research funding from the Dudley L. Moore Nursing and

Allied Health Research Fund and the Rehabilitation Nursing Foundation and to attract the interest of the Georgia Tech Center for Assistive Technology and Environmental Access (CATEA).

"They turned the adaptive crawler into a reality and have continued to adapt it during my research and pilot study to test it at Children's Healthcare of Atlanta," Williams said.

The technicians at CATEA added contour foam for greater comfort and better body alignment; moved the front wheel under the plastic top, so that babies can see better; and made the device longer so that, when children move backward, they don't hurt their feet and legs.

Professors in the doctoral program at Georgia State University helped her devise the research project and design the testing tools that would allow her to measure physical and psycho-social changes in six infants, ages 6 months to about a year. Williams studied the infants in their homes, because she wanted parents to be able to use the device in their everyday lives, not just in therapy.

Two babies in the testing stage weren't able to assume the prone position because of surgeries, but four infants learned to use the crawler extremely well. Those babies increased their upper-body strength and dexterity, improved their cognitive abilities and had greater interaction with their families. One child can walk between a couch and table using braces and can use a standing device with wheels.

"One mother told me that her child had used the crawler to get into her laundry basket and throw the clothes out," Williams said. "Previously, this child just sat on his mother's lap and showed little interest in his surroundings. She told me he was reaching out to other family members now."

Another child who would only cry when set down, now follows his older sister around on his crawler. The two are playing and entertaining themselves.

"Children are supposed to get off their parents' laps, become independently mobile and explore," Williams said. "It's an important part of development, and, if they miss that, it affects later development of language and learning."

More funding

Children's Healthcare of Atlanta's Institutional Review Board has extended funding for the study to continue to age 3. Williams is exploring ways to manufacture the Infant Adaptive Crawler commercially and make it more widely available to rehabilitation practitioners and families.

"The parents in my pilot study are so excited. They tell me that it's an answer to prayer to have something that makes their child less disabled and more enabled. They say it gives them hope that their child will have a brighter future," Williams said.

Williams said that the idea of early learning intervention for patients with spina bifida is new and sometimes meets with resistance, but she's seen the crawler improve the quality of life for infants and their families. "Nurses are holistic, hands-on practitioners. They see things that others don't, and they have ideas to help."