Motor & Gait Development After the 1st Year

11-12 months

Becomes even faster and more proficient at cruising, creeping, pull to stand and lowering to sitting, smooth controlled movements but lots of falls

What are characteristics of initial walking 3-6 months after first learning how to walk

- Unpredictable loss of balance, uneven steps

- High guard

- Lack heel strike, wide base of support (hips ABD and ER), bowing, foot pronation

- Minimal propulsive push-off, lack hip extension, short step length

What are characteristics of immature walking at approximately 2 years of age

- Occasionally loses balance

- Low guard, Reciprocal arm swing

- Heel strike (6mo after independent walking)

- Gaining push off and hip extension, longer step length

What are characteristics of mature walking (>7 years of age)

- Rarely loses balance without perturbation

- Reciprocal arm swing

- Heel strike

- Mature pattern although step length will increase with height/leg length

Development of Gait

- Initial Walking (3-6mo after learning to walk)

- Immature Walking (approx. 2 years old)

- Mature Walking (>7 years of age)

it decreases

What happens to cadence as we age

Velocity and stride length increases

what factors cause cadence to decrease as we age

3-4 years old

when does true running first emerge

toe walking after age 2

what is a red flag for the development of gait

What is the Typical Developmental Sequence for learning stair climbing by age: 8 months - 1.5 years

- Ascends stairs by creeping

- Descends stairs by creeping backwards—may evolve into backwards sliding (usually attempt headfirst before taught to go backwards)

What is the Typical Developmental Sequence for learning stair climbing by age: 1 - 1.5 years

Ascends stairs upright with rail sideways or hand(s) held forward using a step to pattern and descends with a creep

What is the Typical Developmental Sequence for learning stair climbing by age: 1.5 - 2 years

Ascends and descends stairs upright with rail sideways or hand(s) held forward with step to pattern

What is the Typical Developmental Sequence for learning stair climbing by age: 2 -3 years

Ascends stairs upright with support as needed with reciprocal pattern and descends stairs upright with support as needed with a step to pattern

What is the Typical Developmental Sequence for learning stair climbing by age: 3 - 4 years

Ascends and descends stairs upright with support as needed with a reciprocal pattern

Exposure and Experience

what is a crucial aspect of learning how to walk and navigate different environments

Key points about the development of Handedness (R vs. L handedness)

- Birth-12 months look for symmetrical UE and fine motor skills

- At 12-13 months handedness is stable in most children

- At 5 years handedness should be well established

12-13 months

at what age does handedness become stable in most children

5 years of age

By what age should handedness be well established

what are the key points about walking development at 12 - 18 months of age

- Independent at walking and standing: foot flat initial contact, mild varus at knee

- May be first introduced to stairs; uses creeping but may start to ascend upright with support, creeps down

- Moves into a squat position and maintains a squat in play without support

12 - 18 months of age

at what age do children begin to develop the ability to perform independent walking and standing with foot flat initial contact, mild varus at knee and can move into a squat position and maintains a squat in play without support

what are the key points about walking development at 18 months - 2 years of age

- Walks with increased speed and coordination but not yet a true run with flight

- Experiments with jumping (bouncing, step/slide off a step)

- Takes off Shoes

18 months - 2 years of age

at what age do children begin to develop the ability to walk with increased speed and coordination but not yet a true run with flight and experiment with jumping

what are the walking milestones that begin to appear at 2 years of age

- Walks with a heel-toe gait pattern

- Demonstrates more complex gait skills: tip toe walk, backwards walking and more mature run with arm swing

- Non-reciprocal to reciprocal stair climbing up 4 steps with rail. Typically still descends with non-reciprocal pattern (2-2.5yo)

- Jumps off bottom step and Jumps with two feet off the ground

- Tosses and catches a large ball (with less use of trunk support when catching ball)

- Kicks a stationary gym ball ~6ft (brief SLS!)

at 2 years of age

at what age do children begin to develop the ability to walk with a heel-toe gait pattern and demonstrate complex gait skills such as: tip toe walk, backwards walking and more mature run with arm swing

at 2 years of age

at what age do children begin to develop the ability to perform non-reciprocal to reciprocal stair climbing up 4 steps with rail. But typically, still descends with non-reciprocal pattern (2-2.5yo)

at 2 years of age

at what age should children be able to Tosses and catches a large ball (with less use of trunk support when catching ball) as well as kicks a stationary gym ball ~6ft

what are the characteristics of walking and motor learning at 3 years of age

- Rides a tricycle (may initially use feet to propel but learns to use pedals)

- Hops on one foot <3x

- Stands on one foot for 3-5 seconds

- Using an underhand toss, hits a target

- Anticipates catching a ball

- Ascends 4 steps with reciprocal pattern without support (3-3.5yo)

- Descends 4 steps with reciprocal pattern without support (3.5-4yo)

- Early writing, uses utensils

at what age of walking development should children be able to Ascends 4 steps with reciprocal pattern without support as well as Descends 4 steps with reciprocal pattern without support

3 - 4 years of age

what are the characteristics of walking and motor learning at 4 years of age

- Runs with smooth reciprocal arm swing

- Hops on one foot approx. 5x

- Jumps forward approx. 36 inches, up 2-3 inches

- Gallops 10 feet

- Stands on one foot for approx. 10 seconds

- Uses an overhead toss to hit target 12 feet away with trunk rotation

- Catches small ball from 5 feet away

- Progresses to bike with training wheels, balance bike or scooter

at what age are children able to run with smooth reciprocal arm swing, hop on one foot, balance on one foot, and Progresses to bike with training wheels, balance bike or scooter

at 4 years of age

what are the characteristics of walking and motor learning at 5 years of age

- Hops on 1 foot >10x, forward and sideways 2 foot jumping

- Skips at least 10 feet

- Completes 5 sit ups

- Completes 8 push ups

- Extends leg back before kicking a ball

what are the characteristics of walking and motor learning at 6 years of age

- Shows advanced throwing pattern

- Walks forward, backward and sideways on balance beam

- May ride a 2-wheeled bike

- Tests physical limits by dancing, tumbling, climbing

TRUE or FALSE: By around 6-7 years of age, typically developing/neurotypical children generally are proficient with most gross and fine motor skills. As with many skills, practice improves performance; therefore, refinement of already acquired motor skills can continue into adulthood.

True

Emergence and maturation of Running, hopping, and skipping

what are the characteristics of walking and motor learning at 7 years of age

what characteristics of gait are fully matured and developed at 7 years of age

- Spatio-temporal gait

- Kinetics & kinematics

- Muscle activity

Key points about Motor Development in School-Age Children

- Transition from mastering basic coordination to achieving specialized physical skills and athletic abilities. 

- Development is steady, methodical, and strongly focused on refining classroom and physical abilities.

what does gross motor skill development in school age children entail

- Children exhibit smoother, stronger, and more controlled movements.

- They typically master balance and coordination activities such as jumping rope, riding a bicycle, skipping, and throwing or catching.

what does fine motor skill development in school age children entail

- These become highly focused.

- Children develop the precise control necessary for neat handwriting, detailed drawing, playing musical instruments, and manipulating small tools like scissors.

what is brain and body readjustment that occur during adolescence

- Rapid physical transformations of puberty, require the body and brain to recalibrate as teens adapt to longer limbs and larger bodies.

- Adolescents may experience a phase of perceived clumsiness as their brains adjust to their new body size and longer limbs.

Key points about sex differences in adolescence

Before puberty, boys and girls show roughly the same muscular strength. Afterward, boys typically gain an advantage in terms of muscle mass and anaerobic power, while girls often see improvements in flexibility and balance

the development of throwing by age: How is Preparation, Execution and Follow-through?

- 2 years - Flinging ball, overhand

- 2-3 years - Underhand

- 4-5 years - Overhand throw and take step forward

- 6-10 years - Counter-rotation and step back

the development of catching by age: How is Preparation and Reception?

- 2 years - Standing, arms near body and traps ball

- 3-5 years - Standing, arms reaching forward and catch smaller ball away from body

- 6-10 years - Stepping, catching more accurately and smoothly

the development of hitting by age

- 12 to 30 months: Over arm pattern and chops/swats down

- 3 years: Horizontal swing begins, short step

- 4 years: Near adult pattern, diagonal BOS & UE/LE motion

- 7-8 years: Trunk counter rotation, med/lateral weight shift over feet

General Red Flags of walking development

- Loss of previously mastered skill or ability

- Milestones not achieved ( >2 months)

- Continuance of primitive reflexes

- Tone-" opisthotonus" (extensor tone)

- Toe-walking

- "hand dominance"

- Cortical thumb

- Lack of visual tracking

- Bunny hopping

Red Flags by Age: 1 month

- Galeazzi

- asymmetrical skin folds

- excess extension > opisthotonus  

Red Flags by Age: 2 months

- extension

- cramped, asymmetry

- obligatory reflexes

Red Flags by Age: 3 months

- no head control

- no tummy tolerance

- not visually tracking 180 degrees

Red Flags by Age: 4 months

- asymmetry

- no reach or grasp of toy

- no visual curiosity

- complete head lag for pull-to-sit

- ATNR

- unable to roll

- no tummy tolerance

- ATNR still present

Red Flags by Age: 5 months

- unable to sit

- any head lag

- LACK of a Parachute

Red Flags by Age: 6 months

- enjoys supine position

- head lag

- primitive reflexes

Red Flags by Age: 7-8 months

Red Flags by Age: 9-10 months

- unable to attain/ maintain sitting

- no prone prop

- no landau

- no parachute

- no interest in prone mobility

- not pointing or turning when name is called

Red Flags by Age: 11-12 months

any delayed milestones >2 months

- weak suck

- GERD

Red Flags Beyond Motor Domain by age: 1-3 months

Red Flags Beyond Motor Domain by age: 4 months

- not looking or smiling at others

- not cooing

- poor head control

- does not tolerate prone

- no smiling/laughing

Red Flags Beyond Motor Domain by age: 8 months

- lack of bright affect

- no interest in social games

- poor response to name being called

- no pointing

- no babbling

- no sitting

- no rolling

- passive in supine

Red Flags Beyond Motor Domain by age: 12 months

- no words

- not pulling up or cruising along furniture

Red Flags Beyond Motor Domain by age: 14 months

- no interest in other children

- no imitating

- no pointing or eye contact

- not using push toys

- flat affect

Red Flags Beyond Motor Domain by age: 18-20 months

no spontaneous, meaningful, 2-word phrases

What are ways to Determine the Child’s Age

- Fetal age

- Chronological Age

- Prematurity - Adjusted Age

What should be Observed Qualitatively in all Functional Positions when evaluating a child

- Prone

- Supine

- Side lying

- Pull to sit

- Parachute (protective extension downward)

- Sitting (...and all transitions)

- Standing (...and all transitions)

- Horizontal suspension (landau)

- Quadruped and transitions

what are forms of deficits/impairments that could affect the building blocks of movement development

- Abnormal compensatory development

- Contractures

- Deformity

- Surgery

- excessive/abnormal extensor activity

TRUE or FALSE: Most newborns with developmental delay show HYPOTONIC muscle tone

True

Where Do Developmental Blocks Begin?

- Most newborns with developmental delay show HYPOTONIC muscle tone

- Low tone provides a poor base of support

- Baby begins to “fix” or hold joint segments abnormally to acquire stability leading to abnormal righting reactions and abnormal equilibrium reactions

TLR

Low tone only allows extension based on which reflex?

TRUE or FALSE: if babies present with low tone the baby cannot stabilize which causes them to learn to hold segments artificially with compensations leading to "fixing", preventing further movement of that segment resulting in blockage of typical stability and mobility aquisition

True

What are the 4 blocks or segments that are the foundation of human movement

- Neck block

- Shoulder block

- anterior pelvic (tilt) block

- posterior pelvic (tilt) block

Key points about the neck block

- Normal: head and neck hyperextension is being balanced by proximal flexion in the 3rd or 4th month, with midline orientation emerging in all positions

- Active chin tuck serves to elongate the cervical paraspinals

Key points about the Shoulder/Scapular Block

- Poor scapulo-humeral rhythm

- Poor disassociation

- Shoulder elevation

- Weight stays on chest

Key points about Anterior Pelvic-Tilt Block when there is Decreased abdominal development/activation

- No posterior pelvic tilt or lumbar extensor elongation

- No antigravity hip flexion/adduction

- Decreased trunk control

- Lateral weight shift blocked, normal righting reactions decreased

Key points about Anterior Pelvic-Tilt Block when there are compensations

Frog-leg persists leads to Wide BOS in all positions

what are resulting consequences of deficits in the development of the Posterior Pelvic-Tilt Block to sitting

- Tight hamstrings prevent full hip flexion/knee extension

- Posterior pelvic tilt

- Rounded lumbar spine → rounded thoracic spine

- Sacral sit

- Increased knee flexion

- W-sitting

- Bunny hopping

Narrow adducted base of support

what are resulting consequences of deficits in the development of the Posterior Pelvic-Tilt Block to independent standing

Intervention Summary for Atypical Development

- Identify where the baby is blocked in development

- What is interfering with the ability to control posture and movement

- Righting and equilibrium reactions support the baby's potential to explore the world