Normal Motor Milestones PDF

2/29/2024 Through the Lifecycle (PTA 1011) Power Point #3 Normal Motor Milestones istock by Getty Images 1 1  2/29/2024...

2/29/2024 Through the Lifecycle (PTA 1011) Power Point #3 Normal Motor Milestones istock by Getty Images 1 1  2/29/2024 After reading and studying these chapters and the materials presented, the student will be able to: Identify stages of development and motor milestones up through Learning adolescence Understand motor development from Objectives lying to moving in upright positions 2  2/29/2024 Normal Motor Development- Newborn to 1 month old Prone position- lifts head up briefly with head turned to one side (unilateral head lifting) Supine- rolls partly to side Fig. 4-21 Unilateral head lifting in Sitting- head lag in pull to sit (due to postural a newborn. (From Cech D, Martin control not established yet and weak neck S, editors: Functional movement muscles) development across the life span, Standing- positive support primitive reflex for ed 3, Philadelphia, 2012, WB standing and walking reflex- taking a few steps Saunders.) when supported Follows moving objects to midline with eyes Hands fisted Arm movements jerky ©Stanbridge University 2024 3 3  2/29/2024 2 to 3 Months In prone- infant able to elevate head up 45 to 90 degrees from the supporting surface and weight bear on elbows – Spinal extension allows the infant to bring arms out from under the body- to support on forearms in prone Rolls from prone to supine In supine- limbs remain flexed and movements random – limbs do not extend fully yet Fig. 4-22, Martin/Kessler – legs may kick reciprocally Prone on Elbows ©Stanbridge University 2024 4 4  2/29/2024 2 to 3 Months In supine- neck turned to one side- unable to hold head in midline yet ATNR present- see’s hand (strongest influence at 2 months) Head lag present when pulled from supine to sit (head continues to lag behind the body; no postural control yet) Needs full support to sit up and exhibits head bobbing and poor head control Grasp is reflexive; uses palmar grasp Fig. 4-23 Martin/Kessler ATNR ©Stanbridge University 2024 5 5  2/29/2024 Able to lift head in midline up to 90 degrees or past when in prone Critical time in motor and maintain it development because 4 Months posture and movement change from asymmetric to more symmetric Pull from supine to sit- no head lag; head stays in alignment with trunk/body Head control: hallmark motor behavior Maintain midline head alignment with the trunk when infant held upright in vertical position Due to increased head control, cervical spinal Fig. 4-9, Martin/Kessler curve has formed Head in line with the body when pulled to sit ©Stanbridge University 2024 6 6  2/29/2024 Able to bring hands together in midline and watch them; realize they are part of their body Brings hands to mouth and objects to mouth with both Normal Motor hands (beginning of bimanual hand play) Development Martin/Kessler 4 months Pelvic mobility begins- hook-lying position pressing feet on surface posterior pelvic tilt and hip extension occurs (bridges) active hip flexion produces anterior pelvic tilt random pushing off the surface with the LEs provides further practice of pelvic Fig. 4-25 Midline head mobility that will be used later in position in supine. development ©Stanbridge University 2024 7 7  2/29/2024 Martin/Kessler Fig. 4-29 “Swimming” posture, antigravity extension of the body. The voluntary desire to move is the start of cognitive movement and motor planning Rolling is more voluntary, using flexion to roll from supine to prone Decreased influence of ATNR Fig. 4-30 Prone on Ability to cross midline develops extended arms. In Prone- “swimming” posture- further Martin/Kessler manifestation of extensor control against gravity Prone press ups on extended UE’s Normal Motor – Subtle weight shifts in prone and may reach Development- 5 months ©Stanbridge University 2024 8 8  2/29/2024 FIGURE 4-27 A, Use of trunk flexion to reinforce neck flexion as the head leads during a pull-to-sit maneuver. B, Use of leg elevation to counterbalance neck flexion during a pull-to-sit maneuver. Martin/Kessler In Supine- Pulled from supine to sit- head now leads Bottom lifting-“happy with a chin tuck baby”- lengthens – Control of head against hamstrings and gravity in supine prepares for long sitting, Dissociation of head and works abdominals limbs develops- – LE pedaling- kicks one leg then the other “Bottom lifting”- grabbing feet with hands; bringing feet to mouth In Sitting- needs support; Fig. 4-28 Bottom lifting. Depositphotos.com can prop sit while leaning against corner of couch In Stand with support and Normal Motor bouncing- infant gets proprioceptive, kinesthetic and vestibular input Development- 5 Months ©Stanbridge University 2024 9 9  2/29/2024 Fig. 4-31 Prone Pivot 6 Months In prone- begins to rock on belly and prone pivot, may Martin/Kessler pivot in a circle Prone weight on extended arm reaching with lateral shift- lateral righting reaction Fig. 4-32 Lateral Landau reflex-total body righting against gravity righting (should be fully developed) reaction – essential for developing transitional movements – It is mature when the infant can demonstrate hip extension when held away from the support surface, supported only under the tummy – The infant appears to be flying Fig. 4-33 A, Eliciting a Landau reflex. B, Spontaneous Landau reflex ©Stanbridge University 2024 10 10  2/29/2024 6 Months In Supine- pull to sit maneuver becomes pull to stand (Fig. 4-36, A-B) Segmental rolling- preferred mobility pattern (Fig. 4-34 A to C, Segmental rolling from supine to prone) Sitting- Able to sit on floor if placed, may need support at low back or pelvis – the infant’s arms are initially needed for support – with improving trunk control, first one hand and then both hands will be freed from providing Fig. 4-35 Early sitting with a relatively postural support to explore objects and to engage straight back except in more sophisticated play for forward flexion in the lumbar spine Forward protective extension develops in sitting ©Stanbridge University 2024 Martin/Kessler 11 11  2/29/2024 6 Months In Sitting- reaching is maturing – Reaching patterns originate from the shoulder because early in upper extremity development, the arm functions as a whole unit – Pronated reaching is the least mature reaching pattern and is seen early in development – Supinated reaching is the most mature pattern because it allows the hand to be visually oriented toward the thumb side – Fig. 4-37 (Partially) Supinated reaching in Martin/Kessler sitting with other arm propped to support 12 12  2/29/2024 7 months In Prone- pivots in circles both directions Fig. 4-41 Belly crawling – Belly crawling (combat crawling) forward and may go backward Sits independently – trunk control improves in sitting and allows the infant to free one or both hands for playing with objects Lateral protective reactions in sit have emerged FIG. 4-39 Lateral upper extremity protective reaction in response to loss of sitting balance. ©Stanbridge University 2024 Martin/Kessler 13 13  2/29/2024 7 months The different types of sitting postures, such as ring sitting, wide abducted sitting, and long sitting, provide the infant with different amounts of support Side lying to side sit using one UE to push up (propping) Fine motor- finger feeds self Fig. 4-38 Sitting postures. A, Ring sitting propped forward on hands. B, Half-long sitting (figure 4) and C, Long sitting, legs slightly abducted, (Martin/Kessler) ©Stanbridge University 2024 14 14  2/29/2024 Martin/Kessler 8 to 9 months In Prone- Gets into hands and knees position (quadruped) – May rock on all 4’s Fig. 4-42 side sitting Supine position- does not tolerate In sitting- moves from sitting to prone position – Able to pivot in sitting – Sits for longer periods without hand support – Able to side sit Transitions- sitting to quadruped and heel sit to kneel stand 15 ©Stanbridge University 2024 15  2/29/2024 8 to 9 months Standing- pulls to stand at furniture, and in crib Cruising maneuvers (see next slide) Clipart-library.com Mobility- 4-point reciprocal creeping, scooting on bottom, and cruising – Cruising along furniture- cruising is done around furniture and between close pieces of furniture – This sideways “walking” is done with arm support and may be a means of working the hip abductors to ensure a level pelvis when forward ambulation is attempted Increase shoulder external rotation and ability for supinated reaching Freepik.com 16 ©Stanbridge University 2024 16  2/29/2024 8 to 9 months Equilibrium reactions of the feet- baby learns balance in standing by delicate movements of the feet- “fanning” and “clawing” Martin/Kessler Fig. 4-43 (Redrawn by permission of the publisher from Connor FP, Williamson GG, Siepp JM, editors: Program guide for infants and toddlers with neuromotor and other developmental disabilities. New York, © 1978 Teachers College, Columbia University, p. 117. All rights reserved.) 17 ©Stanbridge University 2024 17  2/29/2024 8 to 9 months- Once infants have achieved an upright posture at Cruising Maneuvers furniture, they practice weight shifting by moving from side to side The infant practices dissociating arm and leg movements from the trunk by reaching out or backward with an arm while the leg is swung in the opposite direction When side-to-side weight shift progresses to actual movement sideways, the baby is cruising Martin/Kessler Fig. 4-44 Cruising maneuvers. A, Cruising sideways, reaching out. B, Standing, rotating upper trunk backward. C, Standing, reaching out backward, elaborating with swinging movements of the same-side leg, thus producing counterrotation. (Redrawn by permission of the publisher from Connor FP, Williamson GG, Siepp JM, editors: Program guide for infants and toddlers with neuromotor and other developmental disabilities. New York, © 1978 Teachers College, Columbia University, p. 121. All rights reserved.) 18 ©Stanbridge University 2024 18  2/29/2024 19 10 to 11 Months Stand and balance for 1 sec. without support Pull to stand using partial half-kneel position (see picture above) Take first steps – can walk with 1-2 handheld support Use pincer grasp Puts objects into container ©Stanbridge University 2024 19  2/29/2024 20 10 to 11 Memorangapp.com Months Reciprocal crawls (4- point creeps) over adult lap and other uneven surfaces Bear crawls on hands and feet (plantigrade position) Lowers self down from standing while holding onto furniture without plopping (development of eccentric control) – May pick up a toy/object from floor ©Stanbridge University 2024 20  2/29/2024 12 to 15 Months Stand independently Stoop to pick up something without support Creeps up steps (see picture) Walking without support on level surfaces Typical first steps of walking: – arms in high guard position – scapula adducted and shoulders externally rotated and abducted – elbows flexed and hands extended – hips and knees flexed and hip joints externally rotated – feet pronated; no arches yet – Refer to Fig. 4-45 Fig 4-45 Independent Walking Martin/Kessler ©Stanbridge University 2024 21 21  2/29/2024 16-18 Months Able to walk and pull or carry toy or push toy With help able to walk up and down stairs (2 feet per step) Able to walk backwards and sideways Fast walking and pre-running emerges Pre-jumping Typically developing toddler comes to a stand from the supine position by rolling to prone, pushing up on hands and knees or hands and feet Martin/Kessler Fig. 4-46 E- F (plantigrade), or assuming a squat then rising to a stand (fig 4-46) ©Stanbridge University 2024 22 22  2/29/2024 16 to 18 Months Fig. 4-46 A- D, Progression of rising to standing from supine. A, Supine. B, Rolling. C, Four-point position. D, Plantigrade. Martin/Kessler ©Stanbridge University 2024 23 23  2/29/2024 Common Sitting Postures in Infants/Children Figure 5-4 A- C A. “W” sitting- should be avoided; can hinder development of trunk muscles for balance including trunk rotation and crossing midline; can place abnormal stress on growing joints; children may rely on this posture to increase stability and provide a wider BOS B. Straddle sit or Long sit with abducted LEs C. Ring sitting in infant- propped forward Martin/Kessler on extended arms (feet do not touch) All 3 of these sitting postures provide stability ©Stanbridge University 2024 24 24  2/29/2024 Common Sitting Postures in Infants/Children Fig. 5-15 A. Side sitting without propping B. Side sitting with propping on one arm - One leg is internally rotated while the other is externally rotated Fig. 4-38 B, C B. Figure 4-sitting (half- long sitting) - Infant learns dissociation between LE’s C. Long sitting Martin/Kessler 25 ©Stanbridge University 2024 25  2/29/2024 Common Sitting Postures in Infants/Children Fig. 5-13 A-C A. Long sitting- requires adequate hamstring length B. Ring sitting in child- soles of bilateral feet touch; bilateral hip abduction and external rotation; requires good trunk extensor strength C. Tailor sitting- “crisscross applesauce” (cross-legged) Reduces stress on hamstrings and allows children to sit on their ischial tuberosities 65 Martin/Kessler 26 ©Stanbridge University 2024 26  2/29/2024 Toddler & Early Childhood Development 18 months to 6 years istockphoto.com ©Stanbridge University 2024 27 27  2/29/2024 Toddler & Physiological Development Early Limbs begin to grow faster than their trunk Childhood allowing for greater speed and leverage during gross motor skills (age 5-6) 18 months to 5-year-old brain is 75% of adult weight 6 years Have gained sphincter control to enable toilet training 28  2/29/2024 Toddler & Early Childhood 18 months to 6 years Physiological Development Eustachian tube is shorter and horizontal in children, so they are at greater risk of ear infection The eustachian tube connects the middle ear with the nasal passages and helps balance air pressure in the Puravidasantonio.com middle ear In older children and adults, the tube is relatively vertical, wide, and rigid, and secretions that pass into it from the nasal passages drain easily https://www.merckmanuals.com/home/children-s-health- issues/ear,-nose,-and-throat-disorders-in- children/overview-of-middle-ear-infections-in-young- children chw.org ©Stanbridge University 2024 29 29  2/29/2024 Toddler and Early Childhood Development Gross Motor Milestones 2 years – walk with 24 months – Jumping in increased stride length – place and jumping 3-4 years – ability to run can climb stairs without forward two-footed holding on to rail 5-6 years – mature 3 ½ years – able to walk running, able to do up and down stairs jumping jacks, pump a 4 years – walking pattern independently using swing, jump rope, and similar to adults alternating feet, hop on begin to ride a bike one foot without training wheels ©Stanbridge University 2024 30 30  2/29/2024 Toddler and Early Childhood Development Gross Motor Milestones Types of Jumps: A. Step- down (18 months)- first signs of jumping B. Two-footed jump down step (2 years) C. Jump over obstacles/ hurdles (3 years) D. Two-footed take off and land over obstacle/ hurdle (31/2 years)- rope about 2 inches off floor ©Stanbridge University 2024 31 31  2/29/2024 18 to 24 Months Babycenter.com Most toddlers exhibit a heel strike by 18 months of age One handheld or hold rail to walk up and down stairs (2-feet per step) Squats in play and able to squat to pick up something off floor and return to stand (stoop and recover) Propels ride-on toys Accidental letting go of objects is the beginning of throwing ©Stanbridge University 2024 32 32  2/29/2024 2 Years Old 2-year old’s gait: – Becomes faster – Arms swing reciprocally – Steps are bigger – Increased time in single-limb support Stair climbing and kicking indicate improved stability during shifting of body weight from one leg to the other ©Stanbridge University 2024 33 edu.glogster.com 33  2/29/2024 2 Years Old Ascend/descend stairs one step at a time or may descend with alternating feet with help Clipart-library.com Jump off step with a 2-footed take off and land Single limb balance for 1-3 seconds Kick a large ball and throw a small one Walk and run on tiptoes emerges – Emergence of true running where both feet are off ground- “flight” phase At age 2 1/2- can throw about 5 feet Clipart.com ©Stanbridge University 2024 34 34  2/29/2024 3 to 4 Years Old 3 years old: pedaling a tricycle & climbing jungle gym/ladder Clipart-library.com Ascend / descend stairs reciprocally without help Balance on toes in standing Tandem standing- one foot in front of other 4 years old: hop on one foot & gallop Catch a small ball thrown to them using outstretched arms Striking- swinging and hitting an object ©Stanbridge University 2024 35 35  2/29/2024 5 to 6 Years Old 5 years old: stand on one foot for 8-10 seconds Walk forward on a balance beam alone 2-3 foot standing broad jump forward Clipartlook.com Skipping Underhand and overhand throw and hit a target 5’ away Kick soccer ball airborne 6 years old: bounces ball, roller skating, jump rope, jumping jacks, hopscotch, riding bicycle ©Stanbridge University 2024 36 36  2/29/2024 Ball Throwing Achievements of Preschool Children Fig. 4-49, Throwing distances increase with increasing age. (From Cratty BJ. Perceptual and Motor Development in Infants and Children, 2nd edition. Copyright © 1979 by Allyn & Bacon. Reprinted by permission.) Martin/Kessler ©Stanbridge University 2024 37 37  2/29/2024 Ball Catching Fig. 4-50. Immature catching: A 33-month-old boy extends his arms before the ball is tossed. He waits for the ball without moving, responds after the ball has touched his hands, and then gently traps the ball against his chest. It is essentially a robot-like performance. (From Wickstrom RL. Fundamental Movement Patterns, 3rd edition. Philadelphia, Lea & Febiger, 1983.) Fig. 4-51. A 4-year-old girl waits for the ball with arms straight and hands spread. Her initial response to the ball is a clapping motion. When one hands contacts the ball, the child grasps at it and gains control by clutching it against her chest. (From Wickstrom RL. Fundamental Movement Patterns, 3rd edition. Philadelphia, Lea & Febiger, 1983.) Martin/Kessler ©Stanbridge University 2024 38 38  2/29/2024 2 years – learn to draw – Advance from palmar grasp on marker to grasp with Toddler and fingers – Continue to develop precision with changes in grasp Early Stacks 6 cubes or more Folds paper or clothes Childhood Turns knob 3 to 4 years – draws squares and copies a Fine Motor circle Snip with scissors Milestones May demonstrate hand preference 5 years – mature tripod grasp on marker 39  2/29/2024 Terrible Toddler and Early Childhood Twos! PSYCHOSOCIAL Development Want to be independent Ages 2-4 (toddler): Determined to make own decisions May exhibit temper tantrums Show initiative Ages 4-6 (early childhood): Imitate Peers ©Stanbridge University 2024 40 40  2/29/2024 Communication and Interaction in Early Childhood Piaget’s Pre-operational period- Clipart-library.com -Use of Love dress up play symbolism -Pretend play Begin to think more logically Use words and represent real gestures to objects ©Stanbridge University 2024 41 41  2/29/2024 Vocabulary at 2 years – 200 words Toddler and Vocabulary at 3 years – 1500 words 2-year old: labels and asks simple questions Early 3-year old: expresses thoughts and feelings Childhood 4-year old: tells long stories and exaggerates 5-6-year old: enunciates clearly and asks Language complex questions to learn “what is this for?” or “how does this work?” Skills 42  2/29/2024 Middle Childhood 6 Years to Onset of Puberty 12 years for girls 14 years for boys istockphoto.com ©Stanbridge University 2024 43 43  2/29/2024 Middle Childhood Physiological Development Girls and boys both grow Growth rate slows down 2-3 inches per year – Permanent teeth girls taller at this stage Hearing acuity increases and due to change in At age10 head and brain position of eustachian growth 95% complete tube there is decreased risk of ear infection ©Stanbridge University 2024 44 44  2/29/2024 Refinement of previously Middle learned skills Childhood Repetition and mastery of skills Gross Motor Can practice for hours Example: musical Skills instrument or sports Increased muscle strength More physical at this age Love – climbing, throwing, riding a bike, swimming, and skating 80 ©Stanbridge University 2024 45  2/29/2024 Middle Childhood- Fine Motor Skills Metrokids.com Refined to accomplish things like sewing, using various tools, tying shoes and writing Able to form smaller and smoother letters Switch from printing to cursive ©Stanbridge University 2024 istockphoto.com 46 46  2/29/2024 Middle Childhood- Process/Cognition Piaget – Concrete Operations (age 7- 11) www.massey.ac.nz – Characterized by appropriate use of logic: Begin to think logically about concrete events Mental manipulation of actions; start solving problems in a more logical fashion Inductive reasoning- drawing from observation – Abstract thinking difficult – Hypothetical thinking not developed yet – Struggle with deductive reasoning Prediction of outcomes difficult Example: they may know that A is more than B, and B is more than C, but when asked if A is more than C, they will not know and may not logically be able to figure it out Goodtherapy.org ©Stanbridge University 2024 47 47  2/29/2024 Vocabulary expands Understand puns and figures of speech Jokes based on dual meaning of words – slang, curse words, secret languages Socialized communication – centered around things that they are interested in (school, family, pets, sports) and “taboo” subjects (sex, cursing, and drinking) Middle Childhood Communication/Language skills 48  2/29/2024 Middle Childhood Interaction/Psychosocial Skills Clipart-library.com Peer groups Little Feeling of tend to be communication Separate belonging between boys activities same sex and girls important ©Stanbridge University 2024 49 49  2/29/2024 psychologytoday ADOLESCENCE (Ages 12-20) ©Stanbridge University 2024 50 50  2/29/2024 Adolescence The word adolescence is derived from the Latin word adolescere, which means to grow in maturity or to grow into adulthood Physical changes do occur; however, Know-your-body.wonderhowto.com it is the psychological and social changes that take place that are more evident signs of the onset of adolescence ©Stanbridge University 2024 51 51  2/29/2024 Adolescence - Physical Dramatic physiological changes Neural/hormonal signals to hypothalamus initiate these changes Growth spurt at puberty- height, weight and re-distribution of tissue and muscle mass Boys 8.7 inches on average Girls 7.7 inches on average Sexual development Know-your-body.wonderhowto.com Girls breast growth, hips widen, and menarche begins Boys testes enlargement, growth of facial and body hair, deepening of the voice and shoulders broaden ©Stanbridge University 2024 52 52  2/29/2024 ©Stanbridge University 2024 53 53  2/29/2024 Adolescence- Process/Cognition Immature frontal lobe Unable to understand the dangers of drugs and alcohol More likely to engage in dangerous behavior Drive carelessly / speeding boystown.org Unprotected sex ©Stanbridge University 2024 54 54  2/29/2024 Adolescence – Process/Cognition Piaget’s Formal Operations Period Hypothetic-deductive reasoning Abstract thought Use of logic to solve problems (Algebra) Greater awareness of increased knowledge base Lifestyle.howstuffworks.com Contemplate the universe Why am I here? What’s my purpose on earth? Is there a God? ©Stanbridge University 2024 55 55  2/29/2024 Typically developing adolescents are able to Bilateral coordination skills balance and position their bodies and extremities to allow them to engage in other have fully developed tasks including ADLs and sports: -Independent with hair care, (i.e., curling -Throwing a ball overhead with both hair with curling iron or styling hair) hands -Playing tennis -Swimming -Cheerleading -Jumping jacks -Ironing clothes Adolescence- Motor Development 56  2/29/2024 Adolescence- Motor Development Motor skill performance is characterized by parameters and not by gross motor milestones as seen in younger children – Such as improvements in: Speed Power Strength Reaction time Endurance Learn to calibrate movements – Example: learning to drive then refining driving; proper braking requires calibration Clipart-library.com 57  2/29/2024 Adolescence – Motor Development Increased muscle mass and dynamic strength relates to increases in BMI and physical growth Studies have documented changes in abdominal istockphoto.com and grip strength during adolescence Boys more than girls Better running, jumping, and throwing In girls motor coordination stops developing at about 15 years In boys it keeps on improving into the early 20’s Girls tend to improve more in fine motor skills and do better than boys in this area ©Stanbridge University 2024 Canstockphoto.com 58 58  2/29/2024 Adolescence – Communication/Interaction Skills Manipulate language – Use slang and codes to establish group membership Use of sarcasm Abstract use of language to participate in class discussions Use language to argue for or against a position (debate) that they don’t agree with houpl.wordpress.com ©Stanbridge University 2024 59 59  2/29/2024 Adolescence- Psychosocial Sexual orientation established at this stage Marked experimentation thejournal.ie Poor body image especially in girls Erikson’s Identity vs Identity confusion Goal is to find and understand your identity Sense of self formed by combining past experiences and future expectations gimespace.com ©Stanbridge University 2024 60 60  2/29/2024 Adolescence -Psychosocial Egocentrism – like the 2-4-year-old Think if something is of great concern teensspeak.org to them it is to everyone Imaginary audience Perception that everyone is watching them Self consciousness Think that they are magically protected Nothing bad will happen to them everydayhealth.com ©Stanbridge University 2024 61 61  2/29/2024 Sports related injuries Emotional/mental disorders Common Unintentional accidents Injuries and MVA Illnesses in Substance abuse Teens Near drowning Eating disorders ©Stanbridge University 2024 62 62  2/29/2024 1) At what age should a child be able to walk up stairs without help? a) 2 years b) 3 years c) 4 years Learning d) 9 months Assessment 2) Use of symbolism and pretend play (communication/social skills) are found in the Early childhood development stage, True or False? 63  2/29/2024 3) What stage does Piaget’s concrete operations occur in where the child can use inductive reasoning however deductive reasoning and abstract thinking is difficult? a) adolescence Learning b) early childhood c) infancy Assessment d) middle childhood 4) True or False, teenagers often feel invincible and make irrational decisions? 64