Birth to 3 Months

Question 1

newborn supine

Answer 1

Flexion at elbows, hips, knees and ankles
Extremities close to body and head turned slightly to one side
Because of flexor tightness, recoil is noted at hips, knees, and ankles when legs are moved toward extension (when kicking)

Question 2

newborn prone

Answer 2

everything flexed
Head and neck extensors are the first muscles to exhibit antigravity action
more movement in lower extremities

Question 3

newborn standing

Answer 3

Hips will be flexed and behind the shoulders

Question 4

newborn vision

Answer 4

• Vision is best when object is 8-12 inches away and to the side of the head
• monocular vision
• Can fixate and tract briefly
• Best to capture vision at the side, and tract toward midline
• prefer strong contrast

Question 5

1mo vision

Answer 5

• can track objects from side (45 deg) to midline
• monocular vision
• Can focus on a face
• Difficulty sustaining midline (lateral vision is better)

Question 6

2mo vision

Answer 6

• Control of eye muscles and vision are related to head control
• Can fixate briefly in midline and may be able to track up to 180* horizontally
• Binocular vision is starting—both eyes target and see objects together

Question 7

3mo vision

Answer 7

• Visual convergence begins, which increases ability for midline regard
• Follows toy from side to side
• Downward tracking is poorly developed and will improve as flexor control develops
• Visual tracking is best when head is slightly extended

Question 8

Discuss relationship between head control and vision

Answer 8

If head control is poor, ocular control will be affected
This is because if the baby cannot hold their head steady enough to focus on something, their eyes will not be able to focus on it for an extended period of time, decreasing their oculomotor control

notice the hand when the arm is abducted, to establish head, eye, hand linkage and begin to swipe at toys

Question 9

Describe the synergistic coupling of arms and hands in newborn

Answer 9

The movement of arms and hands are linked together

This means there are no isolated movements at joints

Question 10

importance of decreasing hip flexor tightness in the development of head control and advance movement patterns in the newborn to 3-month-old

Answer 10

• important to decrease hip flexor tightness so that the baby can elongate legs
• At 1mo, there is less weight shifted on the head due to decreased hip flexion and lowered pelvis when infant is in prone
• At 2mo, the hip flexors are elongated enough to permit lowering of the pelvis and resting of the anterior aspect of the thigh on the surface
• At 3mo, the legs will be extended and not kick as much to keep baby in prone position

Question 11

Understand how primitive reflexes affect early infant motor movements

Answer 11

Early standing and stepping patterns of neonate lack participation of hip extensors and the calf muscles, which are needed for dynamic support in standing

Question 12

astasia abasia

Answer 12

• Inability to take weight in standing and poor orientation of feet when they contact the floor
• Happens at 2 months
• Disappears at 3 months and they are able to accept weight in standing again

Question 13

Discuss how the scapula and shoulder girdle provide synergistic stability for early head lifting

Answer 13

When the scapula is retracted, it extends the back and neck, which allows for some lifting of the head. In order for the head to lift, the weight must be shifted posteriorly to the shoulder girdle and, the shoulders and chest are pressed into the support surface.

• newborns: shoulder girdle muscles provide synergistic stability for head lifting
• 1mo: external rotation and active shoulder abduction is starting in supine; upward rotation and increased external rotation in prone
• 2mo: scapular adduction and spinal extension provide synergistic stability for lifting of head and shoulders.
• 3mo: increase shoulder flexion, horizontal adduction, and external rotation

Question 14

Understand the significance of the “frog-legged” position in supine

Answer 14

Frog-legged position allows feet to come together and furthers the development of body awareness and desensitization of the feet
This desensitization helps the baby prepare for standing

Question 15

head control newborn supine

Answer 15

Head is slightly rotated to side because of shape and lack of muscle control
During active head turning, neonate may roll to side because of neonatal neck righting reflex
This indicates lack of disassociation of neck and trunk and limited spinal rotation

Question 16

head control newborn prone

Answer 16

Head and neck extensors are the first muscles to exhibits antigravity activation
Head lifting and turning exercise the capital and cervical extensors, activate lower spinal extensors, provide vestibular stimulation, and initiate spinal rotation
Head extension causes a slight posterior weight shift and turning causes a lateral weight shift

Question 17

head control newborn pull to sit

Answer 17

Visible of babies face that the head is not in alignment with trunk
Size and weight of head prevents the neonate from lifting it and there is a head lag

Question 18

head control 1mo supine

Answer 18

Head rotated further to the side than birth—due to stretching of soft tissue
Increased head and neck extension resulting in chin raising
Neck righting reaction is present and easily demonstrated

Question 19

head control 1mo prone

Answer 19

Movement of head stimulates labyrinthine righting and results in attempts to orient position of head in space
Less weight shifted to head due to decreased hip flexion and a lowered pelvis when infant is quiet
Can lift head higher than at birth
All of this is due to lengthened hip flexors

Question 20

head control 1mo pull to sit

Answer 20

Total head lag is evident with passive extension of upper extremities
Abdominals and lowers don’t participate
Makes attempts to right head with pulled to sit, but unsuccessful because of lack of antigravity flexor control

Question 21

head control 2mo supine

Answer 21

Head rarely in midline
Chin is closer to acromion process
Head rotation may also stimulate neck proprioceptors resulting in ATNR
ATNR should never be obligatory, may occur with no apparent influence on extremities

Question 22

head control 2mo prone

Answer 22

Can extend cervical and thoracic spine and lift head momentarily
Efforts will be made to sustain head lifting which are indicative of the initial development of bilateral symmetrical control
Because extensor and flexor control is inadequate the two month old will demonstrate head bobbing
Head lifting with unilateral extensor activity will be accompanied by some rotation
The decreased hip flexion allows the infant to shift the point of stability to the upper chest

Question 23

head control 2mo pull to sit

Answer 23

Lack of antigravity flexor control will result in head lag

Question 24

head control 3mo supine

Answer 24

Can maintain head midline briefly
Starting to flex the head and tuck the chin
Midline orientation is maintained by capital and cervical flexors
Neck rotation may result in neonatal neck righting
ATNR is seen less frequently

Question 25

head control 3mo prone

Answer 25

Able to lift and control head and to prop on forearms as a result of increased extension and stability of shoulder girdle
Can lift head to 90* without bobbing visual attention has improved as a result of head control
Can track horizontally to 180* and tends to attend with an upward visual gaze

Question 26

head control 3mo pull to sit

Answer 26

When pulled to sit, midline orientation is lost, and the head rotates to one side with some lag noted during the first half of the motion
Once you get to 45* from base, baby tucks chin
This is due to lack of synergistic stability form the oblique abdominals

Question 27

Understand the development of the shoulder gridle to allow for the prone on forearms position in a 3-month-old

Answer 27

Position of 2 months has been modified to increased shoulder flexion, horizontal adduction and external rotation which brings the arms forward and back in toward the body and allows for lifting of the chest from the support surface
Scapular winging may be evident due to lack of stabilizing activity of the serratus anterior