Typical Motor Development: Birth-2years

- Fetal: eight weeks gestation → birth

- Neonatal: birth → 2 weeks

- Infant: 3 weeks → 12 months

- Toddler: 13 months → 2 years old

- Preschooler: 3 → 5 years old

- School Age/Middle Childhood: 6 →11 years old

- Young Teens: 12 →14 years old

- Teenagers: 15 →17 years old

Developmental Classifications (review)

1.Control of the body against gravity

2.Maintain body's COM within base of support

3.Performance of intrasegmental and intersegmental isolated movements

what are the 3 Motor Development Goals

Dynamic Systems Theory

- This theory proposes that movement is produced from the interaction of multiple sub-systems within the person/organism, task and environment

- Sees infant and child development as nonlinear and result of many intrinsic and extrinsic factors

- Rooting

- Suck & Swallow

- Moro

- Neck Righting

- Plantar and Palmar Grasp

- Proprioceptive Placing

- Stepping

- Galant

- Babinski

- Flexor Withdrawal

- Crossed Extension

- ATNR

- TLR

- Positive Support

Primitive Reflexes Present at Birth

- Head righting (LRR, ORR), neck righting, ATNR and grasp dominate

- Flexor withdrawal and crossed extension begin integrate

What is going on with Reflexes & Reactions at 2 months old

- Head righting (LRR, ORR), Landau, STNR dominate, downward protective reaction present

- Rooting, sucking-swallowing, palmar grasp, neck righting, Moro, stepping, positive support, ATNR integrate

What is going on with Reflexes & Reactions at 4 months old

- Prone equilibrium present

- Galant, TLR integrate

What is going on with Reflexes & Reactions at 6 months old

- Supine and sitting equilibrium reactions, parachute and lateral protective extension present

- STNR integrates

What is going on with Reflexes & Reactions at 8 months old

- Quadruped equilibrium reactions and posterior protective extension present

- Plantar grasp integrates

What is going on with Reflexes & Reactions at 10 months old

- Babinski, Landau integrate

- Standing equilibrium reaction emerging

What is going on with Reflexes & Reactions at 12 months old

Stagger and Dorsiflexion protective reactions develop

What is going on with Reflexes & Reactions at 15-18 months old

- Turns in single spot

- Increased demand for weight shifting

- Coordinated movement of UE and LE

- Lateral flexion of the trunk

Key points about Prone Progression: Pivoting/Pivoting in Prone (6 months)

place toys or other items that will get the baby's attention

What can you do as a therapist to facilitate the Pivoting/Pivoting in Prone motor skill?

STNR

What reflex helps develop the quadruped position?

Prone lying (0–2 mo) → Prone on elbows/forearms (3–4 mo) → Prone on extended arms (5 mo) → Pivoting in prone (6 mo) → Quadruped/four-point (7–8 mo) → Crawling/creeping (7–11 mo)

What is the sequence of prone progression development?

0-2 months

At what age is prone lying typically seen

3-4 months

At what age does an infant typically achieve prone on elbows/forearms

5 months

At what age does an infant typically achieve prone on extended arms

6 months

At what age does pivoting in prone typically emerge

7-8 months

At what age is quadruped (four-point) position typically achieved

7–9 months to 9–11 months

At what age does crawling/creeping typically occur

physiologic flexion

What posture dominates prone lying in a healthy full-term neonate

Elevation of the head and rotation side-to-side

What early head movement may be seen in prone lying

to clear the airway

Why does an infant rotate the head side-to-side in prone during early infancy

Weight-bearing through the forearms

What UE weight-bearing begins to emerge during prone lying

Pelvic stabilization

head lifting

movement of the UE out of the neonatal position

What are the major requirements for prone on elbows/forearms

45 degrees

How high can an infant typically lift the head in prone at 2 months

90 degrees

How high can an infant typically lift the head in prone at 3 months

ATNR

Which primitive reflex diminishes during the prone-on-forearms stage

pushing through an open hand

What hand position is emphasized during prone on extended arms

protraction and stabilization

What shoulder girdle action occurs during prone on extended arms

From a static position to weight shifting and reaching

How does prone on extended arms progress over time

By pushing weight posteriorly onto flexed lower extremities

How may infants initially achieve quadruped?

Rotating from sitting through side-sitting

What is another common way infants achieve quadruped

hips

shoulders

trunk

What areas require stability for successful quadruped positioning

Increased lumbar lordosis

What spinal posture is normal when quadruped first emerges

- bunny hop

- indicating difficulty dissociating lower extremities

what are RED FLAGS that may appear during the Creeping 9-11 months (Belly up) phase of the prone progression

attach toys or bells to the feet/ankles or fun socks

What tricks can you do to facilitate the hands to knees and feet motor skill during the supine progression?

With support, demonstrates significant c-curve

Key points about Sitting Progression: Supported sitting (0-4 months)

- Transition to quadruped

- Transition to supported kneeling

What does Increasing use of side-sit to play enable infants to do during the sitting progression phase

supported standing → independent standing → cruising → independent bipedal locomotion

what is the standing progression

7-9 months

Crawling occurs at __-__ months, is also called army crawling, and is performed with the belly down

Nonreciprocal and reciprocal movement patterns

What are the two movement patterns seen in crawling

NO

Does nonreciprocal crawling require trunk rotation

Due to shoulder flexion, the infant may push themselves backward

Why might an infant initially move backward instead of forward when crawling

9-11 months

Creeping occurs at ___-___ months and is performed with the belly up

Proximal control

Reflex integration

Trunk/extremity dissociation

Reciprocal limb activation

What motor skills develop through creeping

Counterrotation

What movement pattern does creeping strengthen for higher-level locomotion

Bunny hopping, which may indicate difficulty dissociating the lower extremities

What is a red flag during creeping

0-2 months

5+

• ___-___ months: Supine lying (physiologic flexion)

• ___+ months: Hands to knees and feet; feet to mouth

Physiologic flexion with slight cervical flexion and the head toward midline

What is the typical posture in supine lying at 0-2 months

About 6 inches away, with a preference for faces

How far can infants typically see during the first 2 months, and what do they prefer to look at?

Pecs

Serratus anterior

Abs

Hip flexors

What muscles are strengthened when infants bring their hands to their knees and feet?

ipsilaterally

Reaching at 5+ months begins _____ and progresses to crossing midline ("controlled asymmetry")

rolling from supine to prone

What future motor milestone does hands-to-feet play help prepare for

0-4 months

At what age does supported sitting occur

5 months (tripod sitting)

At what age does propped sitting typically emerge

Improved anti-gravity control of the neck and trunk

What motor improvement allows an infant to achieve propped sitting

palmar grasp reflex

Which reflex diminishes as propped sitting develops?

6 months

At what age does ring sitting typically emerge

improves midline trunk stability

What is the purpose of the high guard position during ring sitting

Manipulation of objects with the upper extremities

What new skill may emerge during ring sitting

6-7 months

At what age do infants begin weight shifting in independent sitting

7-8 months

At what age do infants begin reaching with trunk rotation

7-8 months

At what age does side-sitting become increasingly used during play

once they start walking out of the house

When should baby get shoes?

if continuously rolling to one side

what is a red flag that can appear during the rolling progression of the transition progression phase

6 months with support

When does supported standing/positive support typically emerge

Hips and knees often remain slightly flexed

What lower-extremity posture is commonly seen during positive support at 6 months?

9-10 months

At what age does independent standing typically occur

high guard

What upper-extremity position is characteristic of early independent standing

cruising

Supported walking while holding onto furniture

9-10 months

At what age does cruising typically begin

Sidestepping along couches or furniture

How do infants usually cruise

Decrease UE support or rotate while grasping objects

What may infants do during cruising to challenge balance

Hip ABD/ADD

Ankle inversion/eversion

What muscle groups and movements are strengthened during cruising

plantar grasp reflex

What primitive reflex may still be present during cruising

12-15 months

What is the average age for independent walking

9-18 months

What age range is considered normal for independent walking

Hip ER

Wide BOS

Lack of heel strike

What lower-extremity characteristics are seen in early independent walking

Pull to sit → Rolling → Side lying to sitting → Sitting to prone → Quadruped to sitting → Pull to stand/lower to sitting → Floor to stand

What is the general sequence of transition progression

5-6 months

At what age does rolling typically emerge

7-8 months

At what age does side lying to sitting emerge

7-8 months

At what age does sitting to prone emerge

7-8 months

At what age does quadruped to sitting emerge

9-12 months

At what age does pull to stand and lower to sitting emerge

12 months

At what age does floor to stand emerge

Physiologic flexion can mimic head control

Why may a newborn appear to have good head control during pull to sit

head lag becomes evident

What happens during pull to sit after physiologic flexion decreases

Recruitment of stronger cervical flexors, trunk flexors, and hip flexors

What change occurs around 4 months during pull to sit

chin tuck

What cervical movement is expected during pull to sit at approximately 4 months

nonsegmental (log roll)

What type of rolling occurs first

4 months

Up to what age is log rolling commonly seen

segmental

What type of rolling develops after log rolling

2 months

At what age does side lying to supine typically occur

4-5 months

At what age does supine to side lying typically occur

5 months

At what age does prone to supine rolling typically occur

6 months

At what age does supine to prone rolling typically occur

Consistently rolling only to one side

What is a red flag regarding rolling development

7-8 months

At what age does the sitting-to-prone transition typically emerge