Stanbridge - T4 - Peds - W3 - Normal Motor Milestones

Introduction

• This document is a presentation on normal motor milestones throughout the lifecycle.
• The presentation is for PTA 1011 students.
• The date is 2/29/2024.

Learning Objectives

• Students will be able to identify stages of motor development through adolescence.
• Students understand motor development, from lying to moving upright.

Newborn to 1 Month

• Prone: Lifts head briefly with head turned to one side.
• Supine: Rolls partly to one side.
• Sitting: Exhibits head lag during pull-to-sit attempts due to weak neck muscles and insufficient postural control.
• Standing: Positive support reflex for standing and walking. Takes a few steps when supported. Follows moving objects to midline with eyes. Hands are fisted. Arm movements are jerky.

2 to 3 Months

• Prone: Elevates head 45-90 degrees from the supporting surface, weight-bearing on elbows. Brings arms from underneath the body for support.
• Supine: Rolls from prone to supine. Limbs remain flexed, movements are random. Legs may kick reciprocally.

2 to 3 Months (alternative)

• Supine: Neck turned to one side; incapable of holding head in the midline.
• Active at-nr response, strongest at 2months.
• Head lags when moving from supine to sitting.
• Requires full support for sitting.
• Head bobbing and poor head control.

4 Months

• Critical time in motor development: posture and movement shift from asymmetric to symmetric.
• Head control: Hallmark motor behavior. Able to lift head to midline to 90 degrees or beyond while in prone and maintain it.
• Pull from supine to sit – no head lag and trunk/head aligned.
• Maintains midline head alignment with trunk when held upright.
• Cervical spinal curve forms due to improved head control.

4 Months (alternative)

• Able to bring hands together in midline
• Hands to mouth and objects to mouth with both hands (bimanual hand play begins)
• Pelvic mobility begins
• Hook-lying position
• Position head in midline while in supine

5 Months

• Voluntary desire to move begins, motor planning starts.
• Rolling is becoming more voluntary.
• Decreased influence of ATNR
• Can cross midline.
• "Swimming" posture emerges in prone (extension against gravity).
• Prone press-ups on extended upper extremities
• Subtle weight shifts in prone; may reach.

6 Months

• Prone: Rocks on belly, prone pivot (potentially in a circle).
• Prone weight on extended arm, lateral shift.
• Landau reflex, total body righting against gravity.
• Essential for developing transitional movements (full development).
• Mature when held away from support surface; supported under tummy (hip extension demonstrated).
• The infant appears to be flying.

6 Months (alternative)

• In supine - pull to sit maneuver becomes pull to stand
• Segmental rolling- preferred mobility pattern
• Sitting- sits on floor if placed, may need support at low back or pelvis
• Infant's arms are needed for support; Improves trunk control initially with one hand then both hands, exploring objects.
• Forward protective extension develops in sitting.

6 Months (alternative)

• Reaching is maturing
• Reaching patterns originate from shoulder; upper extremity functions as a whole unit
• Pronated reaching - least mature - seen early
• Supinated reaching – most mature – hand is oriented towards thumb

7 Months

• Prone: Pivots in both directions (circles), belly crawling (combat crawling).
• Sitting: Independent sitting; trunk control improves; free to play with objects.
• Lateral protective reactions: Emerged in sit.

7 Months (alternative)

• Different types of sitting postures: ring sitting, wide abducted sitting, and long sitting- provide different support amounts
• Side lying to side sitting using one upper extremity to push up.
• Fine motor- feeding self.

8 to 9 Months

• Prone: Gets to hands and knees (quadruped); rocks on all fours (possibly in circles)
• Supine: Cannot tolerate supine to sit; moves from sitting to prone.
• Sitting: Sits for prolonged periods without hand support.
• Side sit: Achieved.
• Transitions: Sitting to quadruped and heel sit to kneel stand.

8 to 9 Months (alternative)

• Standing: Pulls to stand at furniture, crib.
• Mobility: Reciprocal creeping, scooting, cruising along furniture. Cruising is done between pieces of furniture. This "sideways walking" involves arm support to assist hip abduction and maintain a level pelvis during forward movement attempts.
• Increase shoulder external rotation for supinated reaching.
• Equilibrium: Baby learns balance in standing via foot movements (fanning and clawing).

10 to 11 Months

• Standing & Balance: Stands and balances for 1 second without support, pulls up to stand with partial support in half-kneel stance.
• Steps Take first steps with one or two hand held supports.
• Grasp Use a pincer grip; places objects into containers.

10 to 11 Months (alternative)

• Reciprocal crawling (4-point creeps): Over uneven surfaces, adult lap
• Bear crawling (plantigrade): Crawls on hands and feet
• Lowering from standing: From standing, lowers self to the floor while holding onto furniture, avoids plopping down.
• Picking up objects from floor: Picks up toys or objects from the floor.

12 to 15 Months

• Stand independently: Stand independently; stoop to pick up items without support.
• Walking: Creeps up the steps, walks without support on level surfaces.
• First steps: Typical first steps of walking involve arms in high-guard position; shoulders externally rotated; elbows and hands extended; and knees and hips flexed. Feet pronated with no arches.

16 to 18 Months

• Walking: Walks and pulls or carries toys, walks up and down stairs (2 feet per step).
• Walking patterns: Walks backward and sideways, fast walking, pre-running emerges
• Movement and Support Can stand-from supine, rolling to prone, pushing up on hands and knees or hands and feet – plantigrade, or squatting, then stand.

Common Sitting Postures (Infants/Children)

• "W" sitting: Avoid, hinders trunk muscle development, places abnormal stress on growing joints (may use this position to increase stability and support).
• Straddle or long sit: With abducted legs. Propped forward on extended arms (feet don't touch).
• Ring sit: Adequate hamstring length, bilateral hip abduction and external rotation, good trunk extensor strength.
• Tailor sit: Reduces stress on hamstrings, allows for children to sit on their ischial tuberosities; also known as "cross-legged."

Toddler & Early Childhood Development (18 months to 6 years)

• Physiological Development: Limbs grow faster than trunk; allows for increased speed and leverage in gross motor skills (age 5-6); 5-year-old brain is 75% of adult weight; toilet training possible.

Toddler & Early Childhood Development (18 months to 6 years)

• Eustachian tube is shorter and horizontal in children; increased risk of ear infection.

Toddler & Early Childhood Development (18 months to 6 years)

• Gross Motor Milestones: 24 months (jumping, forward two-footed); 2 years (increased stride length, can climb stairs), 3-4 years (ability to run), 5-6 years (mature running, jumping jacks).

Toddler & Early Childhood Development (18 months to 6 years)

• Types of Jumps: Step-down (18 months), two-footed jump down step (2 years), jump/hurdles (3 years), two-footed take-off-land (3 ½ years).

Toddler & Early Childhood Development (18 months to 24 months)

• Motor Milestones (18-24 months):
• Heel strike by 18 months
• Can walk up and down stairs (2 feet per step).

2 years old

• Gait: Becomes faster, arms swing reciprocally, takes larger steps, time in single limb support increases
• Climbing and Kicking: Indicates stability during weight shifting from one leg to the other Climbing, and kicking indicate stability during shifting of body weight.

2 years old (alternative)

• Ascend/descend stairs: one step at a time. Can descend with alternating feet with help.
• Jumping: Jump off steps with 2-footed takeoff and landing; single limb balance is for 1-3 seconds.
• Kicking and Throwing: Kicks and throws small and large balls, walks on tiptoes (running emerges).
• Throwing: Throws objects about 5 feet.

3 to 4 years old

• Abilities: Pedaling a tricycle; climbing jungle gyms/ladders; ascend/descend stairs reciprocally without help; balance on toes while standing; tandem standing; hopping; galloping.
• Catching and Striking: Catches and strikes objects using outstretched arms.

5 to 6 years old

• Abilities: Stands on one foot for 8-10 seconds; walks forward on a balance beam without assistance.
• Jumping: Can perform 2-3 foot standing broad jump forward, skipping, underhand and overhand throwing.
• Skills: Kicks airborne soccer balls, rides a bicycle, performs jump rope, jumping jacks, and hopscotch.

Middle Childhood (Process/Cognition)

• Piaget's Concrete Operations: Characterized by appropriate use of logic, reasoning; Begins logical thought about events
• Mental manipulation of actions, better problem-solving.

Middle Childhood (Communication/Language Skills)

• Vocabulary continues to expand; understands puns, figures of speech; uses slang, curse words, secret languages, and socialized communication focusing on topics of interest (school, family, pets).

Middle Childhood (Interaction/Psychosocial Skills)

• Peer groups: Tend to be same-sex; little interaction between genders.
• Activities: Separate activities.
• Important: Feeling of belonging is important.

Adolescence (Ages 12-20)

• Physical Changes: Puberty onset, dramatic physiological changes, neural/hormonal signals to hypothalamus, growth spurt (height/weight), redistribution of muscle/tissue, sexual development (girls’ breast growth, hips widening, and menstruation; boys’ testes enlargement, facial/body hair growth, deepening of the voice and shoulders broaden).
• Process/Cognition: Immature frontal lobe, unable to understand dangers of drugs/alcohol, drive dangerously/speeding, unprotected sex.
• Piaget's Formal Operations: Hypothetic-deductive reasoning; abstract thought; problem-solving ability; increase in knowledge base; contemplate universe.

Adolescence (Motor Development)

• Motor skills improve in speed, power, strength, reaction time, and endurance; calibration of movements (like driving).

Adolescence (Motor Development)

• Muscle Mass/Strength: Increased muscle mass and dynamic strength directly correlates with growth; stronger abdominal and grip strength.
• Performance Improvements: Continue to improve in running, jumping, and throwing skills and may excel in fine motor skill development.

Adolescence (Communication/Interaction Skills)

• Language: Manipulate language, establish group membership using slang and codes; abstractly uses language during participation in discussions; use language to express arguments or opinions, and take positions they don't necessarily agree with.

Adolescence (Psychosocial Skills)

• Sexual Orientation: Established during adolescence and marked by experimentation; body image may be a significant concern for females.
• Identity versus Identity Confusion: Goal in this stage is to find and understand one's identity. Past experiences and expected outcomes are used to form one's self-concept.
• Egocentrism: • Think everything is extremely relevant and important to them, and that everyone is aware of their behaviors during this period. • Think that they are magically protected and that nothing bad will happen to them. • Perceive that everyone and everything is focused on observing their behaviors, movements, and appearance.

Common Adolescent Injuries/Illnesses

• Sports-related injuries
• Emotional/mental disorders
• Unintentional accidents
• Accidents/MVCs
• Substance abuse
• Near-drowning incidents
• Eating disorders

Learning Assessment (Questions)

• Question 1: At what age should a child typically walk up stairs without help? (Answers: a) 2 years, b) 3 years, c) 4 years, d) 9 months)
• Question 2: True or false - Use of symbolism and pretend play (communication/social skills) is prominent in the early childhood developmental stage.
• Question 3: During which stage does concrete operational thought occur in cognitive development where inductive reasoning is possible, whilst deductive and abstract thought is still challenging? Piaget's concrete operations stage (7-11 years).
• Question 4: True or false- Teenagers frequently believe they are invulnerable and make irrational decisions.