Unit 1 Motor Development
- 1. Motor Development, Motor Control, and Motor Learning in Children
- 2. Unit Objectives • Discuss importance of providing family-centered care, as well as possible barriers. • Describe variation and variability of typical and atypical human development. • Identify various developmental theories. • Describe the presentation of a normal newborn vs a preterm infant. • Describe motor developmental progression in normal children. • Describe typical pediatric reflexes.
- 3. Motor Development and Control Motor Control – Control & organization of processes underlying movement – Milliseconds Motor Learning – Acquisition of skill through practice & experience – Hours, days, weeks Motor Development – Age related process of change in motor development – Months, years, decades
- 4. Kinesiological Concepts of Development Physiological Flexion Antigravity Extension Antigravity Flexion
- 5. Postural Control 1. Mobility 2. Stability – Structural stability – Positional stability – Internal stability – (External stability*) 3. Controlled mobility 4. Skill
- 6. Asymmetry to Symmetry to Controlled Asymmetry
- 7. Normal Newborn Characteristics • Physiological flexion • Flexor recoil with passive stretch • Hands lightly fisted • Head in midline • Visually alert • Moves head side to side to clear airway • Head and trunk are linked • Typical Newborn Examination (video): https://www.youtube.com/watch?v=M8uAPShqjGE
- 8. Premature Newborn Characteristics (<37 weeks) • Decreased physiological flexion • Low muscle tone • Limited ability to self-calm • Can not lift head and neck to clear airway • Immature development of organ systems • Poor feeding skills • Premature Newborn (video): https://www.youtube.com/watch?v=T_d4winmGr4 Click the mouse to move forward.
- 9. The Newborn- Assessment • APGAR score • Measurements – Head circumference – Abdominal circumference – Length – Weight • Physical Examination • Gestational Assessment (http://www.ballardscore.com) – Physical maturity – Neuromuscular maturity Click the mouse to move forward.
- 10. APGAR APGAR Item 0 1 2 Appearance Skin Color Pale or Blue Body normal color, extremities blue Completely normal color Pulse Heart Rate Absent Below 100 Over 100bpm Grimace Reflex irritability response to stimulation to the sole of the foot (light slap) No response Grimace Cry Activity Muscle tone Limp Some flexion of the extremeties Active motion Respiration Breathing Absent Slow, irregular Good, strong cry
- 11. Neonatal/Primitive Reflexes • Part of intrauterine development – Usually appear at end of second trimester – Integrated during first year of life • Developmental trajectory – Deviations indicate abnormal neuromuscular development • Need to observe: – Presence/absence of reflex – Quality of reflex – Symmetry of reflex
- 12. Neonatal/Primitive Reflexes • Needed for survival and development • Used to assess newborn alertness • Many are present in utero but emerge and fade (integrate) gradually • Can be tested through specific procedures • May be elicited passively or actively • Not normally obligatory • Influenced by factors such as body position, behavioral state, time since last feeding, etc…
- 13. Videos of Typical Developmental Reflexes • Rooting Reflex: https://www.youtube.com/watch?v=v7_Y_jg2soc • Moro Reflex: https://www.youtube.com/watch?v=PTz-iVI2mf4 • Plantar Grasp Reflex: https://www.youtube.com/watch?v=6Ch48Sg9mVE • Palmar Grasp Reflex: https://www.youtube.com/watch?v=tZa9XxRthdA • Stepping Reflex: https://www.youtube.com/watch?v=CkGjOwPXsvo • ATNR: https://www.youtube.com/watch?v=pxrnFKwKJUc • Landau Reflex: https://www.youtube.com/watch?v=jEDixMrg1nw • Babinski Reflex: https://www.youtube.com/watch?v=8sbFQQYbYLk • Protective Extension Forward: https://www.youtube.com/watch?v=6fIIbY0WD_M • Protective Extension Sideways: https://www.youtube.com/watch?v=B6ylrJsIzVU Click the mouse to move forward.
- 14. Test Your Knowledge: Reflexes What is reaction that occurs with a stretch to a muscle called? A B C D Deep Tendon Reflex Equilibrium Reaction Neonatal Reflex / Primitive Reflex Righting Reactions Select the correct letter.
- 15. Equilibrium Reactions • Fully developed equilibrium reactions are complex • Function to maintain postural control – Static – Active – Reactive • Described according to neck, trunk and extremity movements • Normally appear at 4-6 months of age in prone & supine • Mature at 4-6 years of age
- 16. Order of Postural Control Prone Supine Side lying Sitting Quadruped Kneeling Standing
- 17. Gross Motor Milestones 2-3 months • Assumes prone on elbows (when placed in prone) 3-4 months • Rolls supine to side lying 5 months • Pull to sit without head lag • Rolls prone to supine • Feet to mouth • Self-supported sitting propped forward on arms
- 18. Gross Motor Milestones 6 – 7 months • Rolls supine to prone • Sits alone without support (hands free) • Sitting equilibrium: Protective extension forward • Transitions quadruped to/from sitting 8-9 months • Cruises sideways • Sitting equilibrium: Protective extension laterally • Creeps (reciprocal on all fours) • Pulls to stand at furniture
- 19. Gross Motor Milestones 10-11 months • Sitting equilibrium: Protective extension backward • Stands alone for short periods • Climbs on hands and knees/feet up stairs • Walks with 1 HHA 12 - 15 months • Walks independently • Squats to play and resumes standing
- 20. Gross Motor Milestones 16 - 18 months • Runs “stiffly” • Walks up and down stairs holding rail (step-to) 2 – 2.5 years • Walks backwards • Walks up and down stairs without support (step-to) 3 years • Emerging adult-like gait • Jumps with 2 feet together • Able to rise on toes and maintain • Throws perpendicular to target
- 21. 4 years • Walks up and down stairs without support (alternating feet) • Tandem walking 5 years • Skipping • SLS for 10 seconds • Hops 8-10x on one foot • Mature throwing pattern (diagonal arm swing, LE wt shift) Gross Motor Milestones
- 22. Resource for Developmental Milestones https://pathways.org/ Click the mouse to move forward.
- 23. Motor Development - Summary • Motor development for typically developing children has a generally predictable sequence. • With deviations in muscle tone, poor quality of movement can be expected. • An assessment should help define if the problem relates to a decreased range of strategies available to the system or an inability to match an appropriate strategy to the motor function
- 24. Typical Motor Development Includes Variability • Motor development is viewed as an innate maturational process that is largely affected by experience • Variability within and between individuals is an essential element in the developmental process • Used for exploration and selection • Provides flexibility in motor performance and motor strategies
- 25. • More stereotyped motor behavior • Delay in achievement of milestones (impaired selection) • Mild or major deviation in muscle tone • Persistence of infantile reflexes • Repertoire of motor strategies is reduced Less Variability in Atypical Development
- 26. Focus of Intervention • Increase amount and variability of experiences • There is not one correct postural control strategy • Design activities that are based on the requirement for the action you are trying to advance • Readiness for new skills • Expand activities for the right challenge • Variable practice
- 27. References • Palisano R, Orlin M, Schreiber J. Campbell’s Physical Therapy for Children, 5th Edition. St. Louis, MO: Saunders/Elsevier; 2017. • Plack, M. Management of the Pediatric Patient Handout. The George Washington University Program in Physical Therapy. 2014 • www.pathways.org