Infant 4 to 6 Months

Question 1

vision 4mo

Answer 1

• Beginning to dissociate eye movements from head movements during tracking
• increased ocular control with synergistic stability from head and neck muscles
• Downward gaze is very important—can touch legs and feel
• Eyes are more specific in reaching and holding and are able to sustain midline convergence

Question 2

vision 5mo

Answer 2

• Reaching more defined
• Head flexes and chin tucks but not able to lift head from support surface without help
• Eyes track in all directions - independent of movement of the head
  Vision used as a guide to reach and grab
  Both hands and feet are in visual field
  Skull side weight shift allows for development of hand-eye coordination because free hand is in visual field

Question 3

vision 6mo

Answer 3

• Can actively and independently tuck chin and lift head
• Thorax stabilized by abdominals for lifting
• Good control of head and neck in side-lying

Question 4

importance of the side-lying position on the development of the ribcage

Answer 4

• Side-lying will maintain symmetry in LE posture
• Side-lying provides new sensory experiences, stimulates lateral head righting, and helps to shape the rib cage and chest

Question 5

face side weight shift

Answer 5

when the weight is shifted to the side that the head is turned (shortens the loaded side). This makes it impossible to reach out with the closest arm to grab an object and limits the ability for coordinated eye-hand reaching.

Question 6

skull side weight shift

Answer 6

a mature weight shift in which the trunk shortens on the unloaded side. This allows for reaching and eye hand coordination while reaching.

Question 7

Describe how the landau reaction affects pivot prone and upright sitting postures

Answer 7

The landau reaction starts to emerge at 4 months. When the baby is lying in prone, the landau reaction causes bilateral symmetrical adduction of the scapulae during head and back extension.
At five months the landau reaction is strong and in pivot prone the baby appears to be swimming with ant-post pelvic tilts and rocking on abdomen, as well as UE movements.
6 months- full manifestation of Landau. Has extension through the hips but display inconsistently.
***In sitting, the extension caused by the landau reaction helps to keep the baby upright.

Question 8

4mo supine to side-lying

Answer 8

Usually occurs in flexed posture with hips and knees flexed, hands together or on knees, and head flexed and rotated
May result from neck righting reaction or asymmetrical posturing of lower extremities (accidental)
Rolling may occur with rotation and extension of the head and neck, but this is a more primitive pattern
If they roll in extension, you will not see lateral head righting

Question 9

5mo supine to side-lying

Answer 9

May roll toward side-lying from flexed posture with hand on flexed lowers and neonatal neck righting
If accomplished from flexed posture, the lower extremities will adjust with the bottom (lower most) extremity adjusting to extension and the top (upper most) extremity staying flexed

Will work on lateral flexion of head, neck, and trunk when rolling
May also roll to side-lying by hyperextending the head and neck and pushing into extension with lowers
If accomplished this way it will NOT promote work on lateral flexion, dissociation of the lower extremities, or development of rolling side-lying to prone

Question 10

5mo rolling prone to supine

Answer 10

Has ability to roll prone to supine by lack equilibrium so cannot control the roll
May start accidentally and proceed to falling onto back if lateral righting of the head occurs
Because of lack of control, this activity frightens the child and, as such, is not practiced much at this time

Question 11

6mo rolling supine to prone

Answer 11

Initiated by flexion, rotation and a lateral weight shift. Top arm comes across body
Uses side-lying to make transition from symmetrical flexion to extension
Transition is made through active lateral flexion—extends head and trunk follows. Moves to a prone on elbows position to complete the roll
Fighting to use head and neck to roll over with flexion

Question 12

6mo rolling prone to supine

Answer 12

Continues to resemble falling. Rarely practice. Extensor dominant activity. Requires extension in lower extremities
Side-lying lateral flexion trunk and neck

Question 13

6mo side lying

Answer 13

Rolls to side-lying easily
Good control of head and neck
Begin to weight bear on bottom UP and uses top UE freely for reaching, grasping, and playing with toys
LE are much more active; uses pre-positioning for postural stability

Question 14

Understand the developmental significance if only a pattern of full body extension is used during early rolling stages

Answer 14

If a baby rolls using patterns of extension, this does not promote work on lateral flexion, dissociation of the LEs, or development of rolling sidelying to prone.

Question 15

Understand the use of positional stability during pull to sit and sitting postures

Answer 15

At 4 months baby can sit unsupported for a few seconds, but by 6 months baby is starting to sit without any support.
Positional stability is provided by ring sitting and leaning forward at hips. This gives the baby a wide base of support. The baby is now able to use his arms for play instead of using them to support his posture

Question 16

pull to sit 4-6mo

Answer 16

4 months- LE has total flexion (anticipatory flexor control)
5 months- LE has total flexion; LE flex at hips and knees with knees adjusting toward extension and movement proceeds
6 months: LE has total flexion and UE pull

Question 17

sitting 5-6mo

Answer 17

5 months: when supported: good head control and movement in all directions- able to reach out and bring toys to mouth; when unsupported: can sit for brief periods of time by propping forward on hands
At 6 months: can sit erect without support; uses ring sitting position, can prop forwards but not sideways; the baby has a protective forward response, but not a sideways.

Question 18

Discuss the movement of the pelvis in supine and prone positions

Answer 18

Supine:
4 months: hip extension is increasing, flexion is still dominant; frog-legged position is being modified
At 5 months: flexes the hips and knees to 90 degrees with increased hip adduction and less external rotation. Can extend the knees while the hips are flexed in order to bring the foot to the mouth.- can bring one foot to mouth, while other leg is extended
6 months: less abduction and external rotation; can play between flexion and extension
Prone:
4 months: Baby’s hips are more adducted and less externally rotated which brings legs in line with trunk; extension at hips, knees and ankles (not full extension)
In prone and supine postures, the 5 month old is working on anterior/posterior control of the pelvis and is beginning to work on lateral and rotational movements through weight shifting and patterns of elongation and shortening.

Question 19

Describe ring sitting and how it provides positional stability for early unsupported sitting efforts

Answer 19

Ring sitting provides positional stability and prevents lateral weight shifting and falling sideways.
Abduction and external rotation are used to stabilize the hips and pelvis and to protect against a fall to the side.

Question 20

Discuss the pre-shaping of the hand prior to grasp and how this occurs

Answer 20

As a baby goes to pick up an object, they learn the position their hand needs to be in to do so successfully, and as time progresses they will start to pre-shape their hand while reaching for a toy. This shows motor planning and forward thinking (feedfoward). This is listed as a 6 month skill

Question 21

Discuss the pre-positioning of the lower extremity to maintain postures

Answer 21

During a pull to sit, baby will start to flex at the hips and knees with the knees adjusting toward extension as the movement proceeds. This puts him in a good position to maintain stability when he is sitting.

Question 22

Describe how the infant stabilizes the quadruped or four-point posture.

Answer 22

Quadruped is typically assumed by the end of the 6th month, but at this time it is a static position.
Stabilized with hip flexors and usually shows lumbar lordosis and anterior pelvic tilt. (sway back posture)

Question 23

Discuss important reflexes and reactions which are present between 4 to 6 months

Answer 23

STNR (5-6mo)
Optical righting (4mo)
Plantar grasp reflex 
Landau (4-7mo)  
Protective response (forward) – emerges at 5 mo
Equilibrium/tilting reaction (6mo)