Four Major Milestone Types
- motor
- sensory
- communication
- feeding
Goals of Motor Development
- control of body against gravity
- maintain body’s COM within the BOS
- intrasegmental and intersegmental isolated movements
What is a Neonate?
0-28 days after birth
- dominated by physiological flexion
- disappears within 1st month of life (if full term)
Prone Lying Positions
- head: turned to one side for breathing and feeding
- UEs: arms adducted into side of body, elbows caudal to shoulders, hands fisted
- Hips: strong hip flexion
- pelvis: ant. pelvic tilt
- butt in the air
Prone on Elbows Positions
- head: ATNR is diminishing, midline cervical extensors used, cervical flexors are developing
- hips: fairly stabilized, need abs and extensors to help; need neutral pelvis or slight post. pelvic tilt
- LE: slightly abducted and ER, knees slightly flexed
- UE: at 2 mos control develops, abducts and flexes shoulders, elbows just below shoulder or slightly ant.; elongation in scapulohumeral
Prone on Extended Arms Significance
- triceps and serratus are active now
- trunk extensors are active
- they can now get up on their hands and begin to reach for things (if stable)
Pivot Prone Significance
signifies scapular and pelvic stability that can alternate
Quadruped Significance
requires hip joint stability, trunk stability, and shoulder stability
Crawling
- 3-9 mos
- “moving slowly by dragging the body along the ground”
- think Army crawl
- belly is on the floor, LEs are passive
Creeping
- 6-7 mos
- “to move across the floor on hands and knees”
- trunk NOT intact with floor
- reciprocal, contralateral movements of UEs and LEs
- may progress to plantigrade creeping (bear walking)
Supine Progression at 5 mos
- ANTR until 4 mos
- when physiological flexion disappears, head lag appears
- head in midline
- “fixing” is observed
- hands to knees and feet, feet to mouth
- shoulder protraction, hands to midline, ipsilateral reach then contralateral, development of body scheme
Non-Segmental Rolling
- 3 mos
- body follows position of the head/neck
- body moves as a unit
- 0-6 mos
- prone to supine around 5 mos
- supine to prone around 6 mos
Segmental Rolling
- 6 mos
- rotation within the spine (intra-axial)
- body moves in separate segments
- prone to supine around 5 mos
- supine to prone around 6 mos
Supported Sitting
- completed C-Curve
- Pelvis is perpendicular to the surface on which he sits
- sacral sitting may indicate a pathology
Propped Sitting
- approx. 5 mos
- diminished hand grasp reflex allows for child’s hands to be placed on ground flat
Ring Sitting
- 6 mos
- no UE support
Half-Ring Rising
- developing dissociation of LE movement
- one hip ER, flexed and knee flexed
- allows for best/most environmental freedom
Side Sitting
- allows most possibility for changing positions
Sitting Progression
Supported sitting –> Propped Sitting –> Ring Sitting –> Half-Ring Sitting –> Long Sitting –> Side Sitting
Standing Progression
- absence of automatic stepping after 2 mos (Abasia)
- lack of weight bearing through LE ( Astasia)
- Pull To stand: 7-8 mos
- Independent Standing: 10 mos - need eccentric control for lowering, will also use tall kneeling and half kneeling
- Cruising
Walking
- ind. bipedal locomotion: plantar grasp must integrate before this, squat play
- walking appears b/t 10-15 mos
- start with high guard –> mid guard
- gait parameters change (age 1-3 yrs)
- running around 3-4 yrs
Head Righting Reactions
- balance
- head attempts to achieve horizontal mouth position
Tilting Reaction
- balance
- surface moves, body reacts
Equilibrium Reaction
- surface doesn’t move, perturbation occurs at body level
