M1 L3: Assessment Gross Motor 0-6 years Flashcards
What are the 6 motor stages in the first 12 months of life?
- Head (sensory & oral) orienting
- Head midline, Sensory orienting, Feeding, Communication
- Floor posture & movement
- Supine, Prone, Side lie, Rolling, Reach, Hands-to-Feet
- Moving up against gravity
- Sit, Sit transitions, Vault
- Quadruped
- Pivot, Commando, Creep, 4 point, Crawl
- Kneel
- Low kneel, High kneel, Pull to stand, Half kneel
- Stance
- Stand at support, Cruise, Transitions, Stand alone
What are the 6 motor stages in the first to fifth years (1-5 years) of life?
- Gait
- Step forward, Walk (6+ steps)
- Propulsion
- Run, jump
- Single leg stance
- Lift 1 foot, Kick, Step up, Stairs up & down, Hop
- Complex gait
- Gallop, Skip, Side skip
- Complex propulsion
- Jump off / over, Jump rope, Jump repetitions
- Ball skills
- Throw, catch, bounce
What is Praxis?
- Planned series of movements to solve a probleme
- A new/novel act- not already learned
(Since children are constantly learning and acquiring skills)
What is a Skill?
Learned ability to bring about pre-determined results with maximum certainty and minimum outlay of time and effort (Eg. elite sports)
What is the development before birth?
What are 4 types of motor movements that begin in utero?
- Kicking, pushing
- Rolling
- Walking
- Fine motor
- (e.g. sucking thumb)
What are the 5 types of sensory movements that begin in utero?
- Pushing (proprioception)
- Mum walking, baby rolling (vestibular)
- Touch self (tactile)
- Baby moving (proprioception)
- Sounds through uterus wall (auditory)
What is the benefit of being in the uterus until full term?
Small constrained environment
- Small range of movement
- Pushing against “constraints”
- Proprioceptive feedback (from uterine wall)
What is the implications of being born pre-mature?
- More nociceptive input (from tubes)
- Less proprioceptive feedback
- For highly premies –> can keep correcting age until school age
What happens when a baby is pre-mature? How does this affect physio?
Premature babies have a “corrected age” where the age starts once they are full term (even while in NICU)
What is the posture of a newborn?
- Term infant (37-40 weeks)
- Flexion of trunk & limbs
What are the 4 characteristics of a newborn’s pattern of movement in the first 2 months?
- general mid‐range limb movement
- some reproducible patterns ofposture / movement
- elicited in response to specific positions / stimuli
- functional: suck, swallow, protective reflexes
What are the 4 newborn responses to sensation?
- ‘Galant’ or ‘trunk incurvation’ response
- ‘Moro’ response
- Primary standing and Primary stepping/walking
- Tonic Labyrinthine Response (TLR)
What is the period of observation in the “Galant” or “trunk” incurvation response?
- Appears at birth (term 37-40w)
- Continues, but weakens with time
What is the stimulus of the “galant” or “trunk incurvation” response?
Tactile – stroking over direct skin/muscle
- Response to non-nociceptive stimuli
What is the response of the “galant” or “trunk incurvation” response?
Underlying muscle contracts
What muscles does the “galant” or “trunk incurvation” response occur?
This type of response is present in many muscles around the body
What are the 3 stimulus of the “Moro” response?
- Vestibular – sudden backward movement of the head
- Some proprioception - extension of the neck
- Some vision - if eyes open / optic flow
What are the 2 responses of the “Moro” response?
- Full arm extension (arms out)- Stiffens
- Then full arm flexion (arms in)
Why do babies have the “Moro” response?
- Head VS body in baby –> 25% of body is head
- Very big compared to the rest of body
- Needs to protect and support the head
What is the implication of swaddling a baby with its hands beside its body?
Swaddle baby with hands on side –> inhibit startle reflex
What is the 2 characteristics of the period of observation for the “Moro” response?
- Appears 0-3w (in term infants, i.e. 37-40 weeks)
- Integrates from 3m+
What are the 2 stimuli for “Primary standing and stepping/walking”?
- Proprioception – weight bearing (for stand)
- Some vestibular and visual – forward lean (for step)
What are the 2 responses of “Primary standing and stepping/walking”?
- Standing - weight bearing through legs
- Stepping - LL flexion, then extension / step
What are 2 characteristics of period of observation of the “Primary standing and stepping/walking”?
- Appears at birth/term (0 weeks)
- Integrates by ~ 1 month (4 weeks)
What is the stimulus for the Tonic Labyrinthine Response (TLR)?
Vestibular - head position to gravity
What are the 2 responses of the “Tonic Labyrinthine Response” (TLR)?
- Supine – neck extended – trunk extends
- Prone – neck flexed – trunk flexes
What are the 2 characteristics of the period of observation of “Tonic Labyrinthine Response” (TLR)?
- Emerges ~ 4w (over the first month)
- Integrates ~ 3m
What is the most important position from 2-4 months of life?
Tummy time in prone is most important during this time –> don’t want baby in supine all the time –> won’t develop new movements
- Coming out of TLR response
- Extending head
Variety of position is determined by parent’s nursing
What are the 3 observations of movements in 2-4 months of life?
- control of posture / movement to gravity and body midline (especially after 3 months)
- adaptive responses to stimuli and positions
- infants respond positively to carers
What are the 2 stimuli in prone for a baby of 2-4 months?
- Voluntary position
- Sensory guided, e.g. sound, sight (DIRECT/DEMONSTRATE level in ORDER)
What is the response in prone for a baby of 2-4 months?
Initially, baby accepts the position when placed by caregiver. Then, baby adapts the position by moving the head and limbs.
What are the 3 periods of observation in prone for a baby of 2-4 months?
- Emerges – Tolerates position at birth, shows controlled weight bearing on elbows by 2-3m and on hands by 4-5m. Eventually rolls into and out of prone by 4-5m.
- Continues – used throughout life. May develop more complex prone skills as needed for sports or occupation, e.g. ‘plank’, or working on floor.
- Precedes – all forms of prone mobility, e.g (rolling*), creeping, crawling.
What are the 2 stimuli for head control for a baby of 2-4 months?
- Voluntary movement
- Sensory guided, e.g. sound, sight
What are the 2 responses for head control for a baby of 2-4 months?
- Baby is able to position their head where they need/want to in order look, listen etc
- Initially, this includes moving the head against gravity and bringing it to the midline. Eventually it includes moving to any position that is anatomically possible.
What are the 2 periods of observation for head control for a baby of 2-4 months?
- Emerges ~ seen by 2-4 months in supine, prone, elbow support, and supported sit
- Continues – used throughout life and will develop as more difficult motor tasks are needed, e.g. sports like figure skating
What are the 2 stimulus for Asymmetric Tonic Neck (ATN) pattern for a baby?
- Proprioception - turning neck/head to the side
- Can be stimulated actively or passively
What is a response for Asymmetric Tonic Neck (ATN) pattern for a baby?
‘Fencing pose’ = extension of facial arm/leg and flexion of occipital arm/leg
What are 3 periods of observation for Asymmetric Tonic Neck (ATN) pattern for a baby?
- Emerges ~ 0-6 weeks, strongest extension in supine ~ 4-8w
- Integrates ~ 12w (3m) obligatory response should disappear as adaptive movement emerges
- Note - can be seen under stress even in healthy adults, e.g. baseball catch in outfield
Standing on one leg will turn their head to that side (if having troubles)
Eg. stand on right leg –> look to the right to try and maintain balance and leg extension
What is a stimulus for Symmetric Tonic Neck (ATN) pattern for a baby?
Proprioception – neck position
What are the 3 responses for Symmetric Tonic Neck (ATN) pattern for a baby?
- Pattern 1: neck extension → UL extend, LL flex (like sitting back on haunches, partial in 4 point kneel)
- Pattern 2: neck flexion → UL flex, LL extend (like looking down at your hands)
- Not as clearly seen as ATN
4 point kneel
- Extend with head
- Extension of arms
- Flexion of legs
- Flex with head
- Flexion of arms
- Extension of legs
What are the 2 periods of observation for Symmetric Tonic Neck (ATN) pattern for a baby?
- Emerges ~ 4-6 weeks
- Integrates ~ 4-7 m, but may be seen in older children/adults when stressed/tired
What are the 3 stimuli for head righting- vertical suspension for a baby?
- Vestibular - linear acceleration (force of gravity) through the otoliths, and angular acceleration through the semicircular canals
- Visual – optic flow / environment alignment
- Somatosensory – neck proprioception, tactile feedback from support surface
What is the response for head righting- vertical suspension for a baby?
As baby’s body is tilted away from vertical, the baby is able to sustain a vertical head orientation to gravity
What are the 2 periods of observation for head righting- vertical suspension for a baby?
- Initially – by 3-6m strong AP and lateral head righting in vertical suspension.
- Continues – throughout life. We develop multi-directional righting in the vertical position, e.g. rollercoaster
What are the 2 stimuli for head/body righting- horizontal suspension for a baby?
- Sensory systems as for vertical suspension
- In this case, the baby’s body is suspended in a horizontal position – supine/prone/right/left
What is the response for head/body righting- horizontal suspension for a baby?
The baby is able to ‘right’ (extend) their head, trunk and limbs up against gravity
What are the 2 periods of observation for head/body righting- horizontal suspension for a baby?
- Emerges – by 3-6m.
- Continues – throughout life, although as limb weight increases it will be less obvious. We develop multi-directional righting to control ourselves against gravity, e.g. rollercoaster
What are the 3 stimuli for head/body righting (somato-sensation) for a baby?
- Somato-°©sensation (especially proprioception) – joint position, muscle stretch, skin stretch
- Detecting a position of ‘discomfort’ that needs to be ‘corrected’
- Can be generated passively through facilitation, or actively through movement
What are the 2 responses for head/body righting (somato-sensation) for a baby?
- Segmental ‘righting’ to bring body segments back into alignment
- Named according to stimulus and response:
- Body-on-Body, Head-on-Body, Body-on-Head
What are the 2 periods of observation for head/body righting (somato-sensation) for a baby?
- Emerges – gradually from birth. Most show Body-on-head from ~ 2m, Body-on-body from~ 3m, Head-on-body later from 4m+
- Continues – remains through life
What are the 3 stimuli for head control (rolling) for a baby?
- Voluntary movement
- Sensory guided, e.g. sound, sight
What are the 2 responses for head control (rolling) for a baby?
- Baby is able to move their body to where they need/want to in order look, listen etc
- Initially, this includes en-bloc rolling from prone to supine and reverse. Then as body-on-body responses improve segmental rolling is seen.
What are the 2 periods of observation for head control (rolling) for a baby?
- Emerges ~ seen by 4 months (pending experience in and tolerance of prone)
- Continues – used throughout life and will develop as more difficult motor tasks are needed, e.g. getting in and out of bed, modern dancing, swimming
What is the most important actions during 5-6 month of life?
Rising up against gravity
- Sitting (support or independent)’
- Advanced prone
What are the stimuli (2), response (2) and periods of observation (2) for hands to feet for anti-gravity flexion for 5-6 months of life?
Stimulus
- Voluntary movement
- Sensory guided, e.g. sound, sight, touch
Response
- Abdominal contraction + postural stability in supine: baby is able to bring their hands-to-feet and balance in supine
- Initially, this includes hands-to-knees, then hands to feet. There is a strong correlation with the subsequent ability to use the abdominals to sit unsupported.
Period of observation
- Emerges ~ seen by 6 months
- Continues – used throughout life and will develop as more difficult motor tasks are needed, e.g. putting on shoes and socks, drop-kicking a football
What are the stimuli (2), response (2) and periods of observation (2) for sitting when placed for 5-6 months of life?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Postural muscle contraction and coordination for stability in upright position
- Initially, this includes sit with support, the sitting alone.
Period of observation
- Emerges ~ sit with support by 6 months, sit alone by 7m (Denver II)
- Continues – used throughout life and will develop as more difficult or combined motor tasks are needed, e.g. sitting at a desk, playing piano, driving a car
What is the 3 progressions of sitting in a 5-6 month of baby?
What are 8-10 month old babies’ actions?
What are 4 general principles of movement during observation?
- Control of posture / movement up against gravity
- Adaptive responses to stimuli and positions
- Combining gross motor and fine motor actions
- Large number of transitions emerge (ability to change from one position to another)
What are the stimuli (2), response (2) and periods of observation (2) for creeping (prone progression - movement) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Reciprocal arm and leg flexion, then weight bearing, then extension to propel the body forward in the prone position with the tummy remaining on the floor
- Requires good (i) ability to dissociate the 2 sides of the body, (ii) postural control of diagonal weight shift, (iii) hip ROM
Period of observation
- Emerges ~ 6-8m
- NB: some children use ‘Commando crawl’ = straight legs
What are the stimuli (2), response (2) and periods of observation (3) for 4-point kneel (position) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Neck and arm extension, hip and knee flexion, then weight bearing in the prone position with the tummy off the floor
- Important for postural control development in the trunk
Period of observation
- Emerges from ~ 6-8m
- Precedes – crawling, kneeling, ‘pulling to stand’
- Continues – throughout life and will be integrated into everyday task series, e.g. washing the floor, retrieving something from under a table
What are the stimuli (2), response (2) and periods of observation (2) for crawling (prone progression- movement) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Reciprocal arm and leg flexion, then diagonal weight sift into weight bearing on those limbs, then extension to propel the body forward in quadruped position with tummy off the floor
- Requires good (i) ability to dissociate the 2 sides of the body, (ii) postural control of medio-lateral (diagonal) weight shift, (iii) positive support through the limbs
Period of observation
- Emerges ~ 10m
- Continues – throughout life and will be integrated into everyday task series, e.g. washing the floor, retrieving something from under a table
What are the stimuli (2), response (2) and periods of observation (2) for attaining sitting (movement-transition) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Action 1: prone –> haunches –> reverse vault
- Action 2: prone –> split legs –> long sit
Period of observation
- Emerges ~ 8-10m +
- Continues – action 1 remains available throughout life, action 2 may not be possible for adults who tend to have less hip ROM
What are the stimuli (2), response (2) and periods of observation (2) for attaining 4 point/quadruped (movement-transition) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Action 1: sit –> vault forward –> 4 point
- Action 2: prone –> haunches –> 4 point
Period of observation
- Emerges ~ 8-10m +
- Continues – action 1 & 2 remain available throughout
- life
What are the stimuli (2), response (1) and periods of observation (2) for attaining 4 point/quadruped to stand (movement-transition) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Reaches up to support with arms, then uses arms to
- pull self up to stand i.e. does not use 1/2 kneel action
Period of observation
- Emerges ~ 10m +
- Integrates - once can use 1/2 kneel, or stand through squat
In postural responses (6-10months), when the COM is raised, ___ _____ control becomes very important
dynamic postural
What are 3 protective and parachute reactions in babies from 6-10months?
- 6 months: forward arms & downward legs
- 8 months: sideways arms
- 10 months: backward arms
What are 2 characteristics of equilibrium responses for postural responses from 6-10months?
- From 10 months - may inhibit need for backward protection at 10m
- Counterbalance disturbing forces
What are 2 main activities that 12 month olds do?
Normal range 8-16 months
* walking at their 1st birthday
Supported standing, steps in supported standing, sitting independently in different positions
What are the stimuli (2), response (1) and periods of observation (3) for cruising (in standing- movement) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Stands at support, then steps sideways to move around object – e.g. ‘furniture walking’
Period of observation
- Emerges ~ 6-10m +
- Integrates - once can stand and walk alone.
- Also seen in adults when under high postural demand, e.g. walking on a boat with rough seas
First series of steps –> side stepping (hip abduction control)
Why is cruising so important for babies? What happens when babies don’t start walking?
This cruising and WB starts to form the femoral neck angle and deepens the acetabulum
No walking –> no deepening of acetabulum and less angle –> highly prone to hip dislocation (hip surveillance)
What are the stimuli (2), response (1) and periods of observation (2) for stand alone (position) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Stands at support, then stands when placed, then alone, then rise to standing
Period of observation
- Emerges ~ 11-14m +
- Remains - throughout life
What are the stimuli (2), response (2) and periods of observation (2) for first steps (movement) for an 8-10 month old child?
Stimulus
- Voluntary movement/position
- Sensory guided, e.g. sound, sight, touch
Response
- Independent walking
- Wide-based
- Feet flat: weight on medial border
- Hips and knees slightly flexed
- Upper trunk extended
- Arms abducted to maintain net COM over BOS
- Early gait pattern
- lateral weight shift over one leg then the other
- “Waddling” type pattern
Period of observation
- Emerges ~ up to 11-18m – wide variation due to exposure and facilitation
- Stepping throughout life, but action is refined
What action can 15months old + can do?
Upright locomotion
What is the maturing gait pattern (movement)?
Increasing functional balance and central stability so that by 2 years children can change from the waddling side-to-side gait to the ability to step forward
What are the 3 stages of standing balance from 15months to 2 years?
What are the 2 sitting variations for 15months to 2 years?
- Long sitting
- Side sitting
What does long sitting require in a 15month - 2 year old?
Good hamstring length, abdominal activation and endurance
What is the period of observation for long sitting in a 15month - 2 year old?
18m+ remains for life if adequate hamstring length
What do 2 requirements of side sitting in a 15month - 2 year old?
- Dissociation between 2 sides of the body – IR upper hip and ER lower hip; LF upper side and LE lower side
- Good postural control
What is the period of observation for side sitting in a 15month - 2 year old?
18m+ remains for life
What is a requirements of kneel in a 15month - 2 year old?
Abdominal activation and endurance, good knee ROM
Get up against gravity
What are the 2 characteristics for period of observation for kneel in a 15month - 2 year old?
- 2y+ remains for life if adequate ROM
- High kneel emerges after standing helps develop hip extension
What are 2 requirements of squat down and stand up in a 15month - 2 year old?
- Agonist/antagonist coordination
- Good postural control – eyes up
Should maintain head up –> children with disability –> head down –> get more flexed –> harder to stand up again
What is the period of observation for squat down and stand up in a 15month - 2 year old?
18m+ remains for life
What is a requirement of single leg stance in a 15month - 2 year old?
Postural control – mediolateral weight shift, positive support, endurance
What are the 6 characteristics for period of observation for kneel in a 15month - 2 year old?
- 2-3y: lift foot momentarily for step up, getting dressed with assistance from caregiver
- 4y = can kick a ball, ascend/descend stairs, don and doff shorts/undies whilst standing up
- 6y = kicks well, stairs without a rail, can don/doff longer trousers while standing up
- Continues – throughout life, and will be more highly developed in people who do certain sports and activities, e.g. Ballet
- Precedes – dynamic SLS skills such as hopping, galloping and skipping
- Deteriorates - in older age due to loss of sensory function and endurance
What is the period of observation for propulsion in a 15month to 2 year old?
by 2y the child has a basis for development of more efficient, effective postural control and balance and skilled movement
What are 5 features of propulsion in a 15month to 2 year old?
- Run – 2y (Pushing upwards with legs)
- Jump - 18m hands held, 2y alone, 3y with feet together, 4y over a suspended rope, 5y standing broad jump, 6-7y turning a skipping rope
- Hop – 3 times by 3y
- Gallop – 5y
- Skip – 50% of 5yo, most 6-7 yo, depends on exposure
What are 2 other skills for 1-5 years old?
What are the 3 interactions of environment for 1-5 years?
