Motor Development ◡̈

In a normal loading response, ____________ on the weighted side and ___________ on the unweighted side

Elongation; shortening

Random- Spontaneous Non-Purposeful Movements

• Newborn can lift head momentarily and turn it to the other side

• Random kicking and UE movements in supine and prone

Bilateral Symmetry

• Infant can lift head in prone and orient the head. The face is vertical and mouth is horizontal.

Why doesn’t a child have control over midline orientation of head at 3 months old in supine?

Antigravity flexor control is underdeveloped

Alternate Reciprocal Movements

• At 3.5 months, baby lifts head in a bilateral symmetrical patterns and turns it to one side or other with purpose and control

Unilateral Symmetrical

Flexor and extensor muscles on the same side work together and are balanced to produce lateral movement of the head and/or trunk

Unilateral Symmetrical movements are first seen during as…

Lateral tilting of the head @ 4 months

Diagonal Reciprocal

• Most advanced, require the ability of the first four movements

• Involves activity of the contralateral upper and lower extremities working across the trunk

  • There is a weight shift. Trunk will elongate (weighted) and shorten (unweighted)

Structural Stability

• Soft tissue tightness due to in utero positioning, occurs when newborn is placed in prone

  • Baby can maintain a flexed position because of tightness of the flexor muscles

Positional Stability

• Infants begin to move into antigravity posture

  • Achieved by using the body/body parts to create a large based of support (standing/sitting with legs widely abducted, support on arms)

Internal Stability

• Develops righting reactions, protective extension, and equilibrium reactions

  • Has internal control mechanism that allows baby to maintain position or posture without the need for position control

As ___________ ____________ develops, the size of the base of support will ___________

Internal stability; decrease

Pull to Sit maneuver

• In supine, grasp infant’s hands and pull towards you.

• Head lag due to lack of antigravity flexor control until 3-4 months

Palmar Grasp

Radial Palmar Grasp

Lateral Pinch/Scissor Grasp

3 Jaw Chuck

Superior Pincer Grasp

Inferior Pincer Grasp

Ring Sitting

Most stable position, used when engaged in fine motor skills

Long Sitting

• Progresses from abduction and semi-extension of knees

• Requires elongation of hamstrings

Side Sitting

Wide BOS with combination of internal and external rotation

W Sitting

• Promotes muscle imbalances, hypotonia, inhibits transitions to other sitting positions, and inability to actively engage in play due to restricted ROM

Physiological Flexion

Position of newborn in utero that elongates the extensor muscles, making these muscles powerful against gravity

When do the flexor muscles become stronger?

When the newborn begins to lift their head in prone. By 4 months, we see indications

Antigravity _________ control precedes antigravity _________ control

Extensor; flexor

What are the development and musculoskeletal benefits of side lying?

• Provides new sensory experiences, stimulates lateral head righting and helps to shape the rib cage and chest.

  • Promotes gross motor development as the precursor to rolling over

Which reflex is only present in preterm and sometimes full term infants?

The Tonic Labyrinthine Reflex

What happens if the Tonic Labyrinthine Reflex doesn’t integrate?

• Child is unable to achieve supine flexion or prone extension

• Child is unable to lift head to clearly airway in prone

• Child is unable to bring hands to mouth in supine

• Moto development is delayed

Which reflex emerges at 1-2 months (strongest at 2 months) and should be integrated by 5-6 months?

Asymmetrical Tonic Neck Reflex

What happens if the ATNR persists?

• CNS dysfunction

  • Inability to engage hands in midline

  • Scoliosis

  • Subluxation/dislocation of hip on skull side

  • Inability to grasp and regard an object at the same time

  • Inability to separate movements of the head from movements of the arms and trunk

Which reflex emerges at 5-6 months and integrates by 9-11 months?

Symmetrical Tonic Neck Reflex

What happens if the STNR persists (doesn’t integrate)?

• Prevents child from moving trunk and extremities in rotational patterns when the head is in a sagittal plane

• Inability to crawl

Tracking for the neonate is easiest when…

Objects are moving laterally and vertically

At what age can the infant only track objects from side to midline?

1 month old

For a 2 month old, what does tracking look like?

• Tracks 180 degs horizontally

• Can track past midline with concurrent eye and head movement

How does a 3 month old track?

• Best when head is slightly extended

  • Downward tracking is poorly developed

Neonate’s Monocular Vision

• Eyes function independently

  • May not coordinate movements of both eyes resulting in occasional eye wantder

Monocular Vision for the 1 month old

• Better control of their eye muscles

  • Begin coordinating their eyes more effectively

At what age does binocular vision start?

2 months

Binocular Vision for 3 month old

• Both eyes are working together to create a single unified image

  • This is critical for depth perception and accurately perceiving the three-dimensional world

The neonate’s acuity is best when

Object is 8-12 inches away

When is lateral vision better than midline vision

At 1 month old

At 2 months, infant is better as focusing on objects/faces within _____ __________

Arm’s reach

When does the infant begin to show interest in objects/patterns with high contrast (black or white)?

As a neonate

For a 3 month old, acuity looks like?

• Can focus on objects at a moderate distance

  • Better at tracking and recognizing faces from a short distance

When does convergence begin?

At 3 months

Convergence increases

Midlines regard ability

At 4 months, how is reaching accomplished?

• Active shoulder adduction with flexion and internal rotation, forearm pronation, and wrist/finger extension

• Uses bilateral reaching patterns but one arm reaches the object first

• Can’t actively control supination, manipulate or release the toy

In what way can you improve reaching in a 4 month old?

By applying pressure to abdomen

At what age is reaching for toys more successful near the chest but reaching into space is difficult?

4 months

At 5 months, what does reaching look like?

• More refined and guided by vision, using a bilateral symmetrical approach

• Can now reach to knees, lower legs, and feet due to improved control of shoulder flexion and adduction

• In sitting, can reach out for toys when supported and bring to mouth

• Manipulation begins

What grasp does a 5 month begin to use

Palmar grasp

At 6 months, what does reaching look like?

• More directed/precise.

• Can reach with one hand or both

• Wrists are extended and can preshape hand when reaching with for a familiar object

  • Reaches with pronation and wrist/finger extension but uses wrist flexion depending on position or toy.

What grasps are used at 6 months?

Palmar or radial palmar grasps

Rocking forward and backward in quadruped helps with which arches

Longitudinal

Rocking laterally and diagonally in quadruped helps with which arches?

Transverse and oblique arches

The longitudinal arch runs from _____ to _________

Wrist; fingers

The transverse arch is the

Concavity of the wrist

The oblique arch is formed by

The thumb opposing the fingers

How does crawling help with the development of the arches of the hand

The repetitive movement and weight-bearing on hands helps to develop and strengthen arches

What motor skills are involved climbing?

Upper extremity and pelvic weight shifts, elongation of the weight bearing side, lateral righting of the trunk and pelvis, flexion, abduction, and external rotation of the unweighted leg.

What problem-solving abilities does climbing develop?

Managing the body on unfamiliar, uneven, and unsteady surfaces.

What gross motor skills are present/emerging in a typically developing 12-month old?

• Sitting

• Creeping

• Climbing

• Kneeling / Half-Kneel

• Rise to Stand

• Standing

• Walking Unsupported

When does creeping integrate?

At 12 months, as unsupported walking starts