Normal Development Notes (0-18 mo)

Question 1

Give the 3 theories of human development.

Answer 1

1) Neuromaturational View
2) Dynamic Systems
3) Neuronal Group Selection Theory.

Question 2

Which of the 3 theories of human development says that variation and variability are the keys to development and that while the sequence uses multiple systems the CNS is best?

Answer 2

NGST

Question 3

Which theory states that the CNS only determines the sequence of development?

Answer 3

Neuromaturational

Question 4

Which system has more grey areas with development and says that multiple systems are equivalent to the CNS in determining the sequence of development?

Answer 4

Dynamic Systems

Question 5

Describe the general changes happening during each of the trimesters or pregnancy.

Answer 5

1) First: By 7 weeks you have a full baby who kicks and moves.
2) Second: There are no new movements and by the end the gross motor skills are decreased.
3) Third: Fine motor skills increase (things like sucking, hand to hand, etc)

Question 6

What are the 6 directions in development?

Answer 6

1) Cephalic control before caudal
2) Extensor antigravity control before flexor antigravity control
3) WB on flexed extremities before extended extremities
4) Gross motor before fine motor
5) Proximal before distal control
6) Reflex before cortical control

Question 7

Name the progression for an infant starting with prone.

Answer 7

Prone, supine, rolling, sitting, WB

Question 8

Describe the how you would find a newborn-1 month old in prone.

Answer 8

1) Physiological flexion
2) Neck: flexion and full cervical rotation
3) UE: hand nuzzles mouth
4) LE: Triple flex (DF =70 with foot hitting tibia)
5) Movement: Caudally up
6) Wt Shift: backwards to lift up head

Question 9

Prone Progression for the 2 month old.

Answer 9

1) Asymmetry
2) Neck: 45 ext 45 Rotation
3) UE: Still flexed and elbows behind shoulders
4) LE: less flexed and in a frog leg position
5) ATNR

Question 10

What is the 3 month old Prone Progression?

Answer 10

1) Symmetry
2) Neck: 90 ext and full rotation from horizontal
3) UE: elbows underneath shoulders, shoulder girdle very active, still on forearms. Hands are still fisted with some opening and closing.
4) LE
5) Movement

Question 11

Give the 4 month old prone progression.

Answer 11

1) Strong symmetry
2) Neck: 90 ext and bilat. 90 rotation
3) UE: on forearms working towards extending arm
4) LE: still in frog leg position
5) Weight shift: towards face side or toy/object

Question 12

What would you see from a 5 month old in prone?

Answer 12

1) Neck: 90 ext. with a good chin tuck; can coordinate flexion/extension in prone
2) UE: ext with open hands, elbows in front of shoulders, grasping and releasing.
3) LE: still in frog leg with some dissociation between the LE
4) Wt. Shift: Lateral wt shift with reaching.
5) Swimming: trunk on ground with UE and LE off.
* *Getting ready to pivot in this stage**

Question 13

What is the 6 month old model in prone?

Answer 13

1) Neck: all controlled at this point
2) UE: ext with mature wt shift without collapsing.
3) LE: similar to 5 mo, not stuck in frog leg
4) Movement: pivoting

Question 14

Describe the 7 month old prone progression

Answer 14

1) UE: ext and reaching in all positions
2) LE: WB through knees
3) Transitions: sit prone, prone quad
4) Movement: not quite creeping but rocking a lot in quad

Question 15

What is the prone progression for 8+ months?

Answer 15

1) Transitions: in and out of side sit bilat.
2) Plantigrade: UE and LE ext (down dog in yoga)
3) Creeping: This should be happening.

Question 16

Give the 1 month old supine progression.

Answer 16

1) Physiological flexion
2) Neck: not in midline with some rotation
3) UE: Scapulas retracted back with flexion
4) LE: flexed with some frog leg
5) Movements: variable kicking and reciprocal sweeping

Question 17

What is the supine progression for a 2 month old?

Answer 17

1) Asymmetry: ATNR
2) Neck: Can’t stay in midline for very long
3) UE: can’t do hand to mouth
4) LE: frog leg position, legs do some extension

Question 18

Describe how you would find a 3 month old in supine.

Answer 18

1) Shift to symmetry
2) Neck: learn to track 180, neutral midline
3) UE: can bring hands to chest to play with toy
4) LE: Kicking reciprocally and increased foot-foot play

Question 19

What is the supine progression for a 4 month old?

Answer 19

1) Neck: head at midline always with a nice chin tuck
2) UE: off chest and can bat at toys above them
3) LE: antigravity control increases in LE and abs
4) Mirroring: LE mirroring (sometimes with UE too)

Question 20

Describe the position of a supine 5 month old

Answer 20

1) UE: reaching is bilat. and symmetrical
2) LE: decreased mirroring between the UE and LE; LE stay flexed when reaching
3) Movements: Alternate bridging and pulling into full flexion
4) Happy Baby: grabs underside of same side foot, this works abs and is when they find their feet and try to eat their toes.

Question 21

Give the supine progression for a 6 month old.

Answer 21

1) Increased UE and LE dissociation
2) UE: can transfer toys between hands
3) Trunk: controls sway of legs and can stop roll if they want to
4) LE: dissociation happening; can put foot on opposite knee
5) Rolling starts

Question 22

What is the 7 month old supine progression?

Answer 22

1) NOT HAPPY IN SUPINE; start fighting diaper changes
2) Neck: full flexion in antigravity
3) Movement: roll to prone
* *If the baby still likes supine at this age there may be something wrong**

Question 23

Give the general characteristics and red flags for a newborn/1 month old.

Answer 23

1) General characteristics: Physiological flexion of all extremities in all positions and swiping movements of extremities.
2) Red Flags: Extended posture, no flexor recoil, absent primitive reflexes

Question 24

In the second month what characteristics would you be looking for and what would be a red flag?

Answer 24

1) General Characteristics: Greatest asymmetry (ATNR), disorganized motor movements
2) Stiff or floppy extremities, little movement in extremities.

Question 25

Month three would show what characteristics and red flags?

Answer 25

1) General Characteristics: Symmetry and midline orientation. 2) Strong asymmetry with extremities and no attempt to lift head in PTS

Question 26

By month 4 what characteristics should you see in the baby? What would you not want to see?

Answer 26

1) General Characteristics: Strong symmetry and increased control of flexion and extension. 2) Red Flags: Poor midline and arches body when attempting to roll.

Question 27

Give what characteristics you should see and the red flags for a 5 month old.

Answer 27

1) General Characteristics: Lat. wt. shift in pring, increasing dissociation. 2) Red Flags: Strong extension in LE or head lag in PTS.

Question 28

Month 6 should show which characteristics? What would be considered a red flag at this age?

Answer 28

1) General Characteristics: Indep. rolling and sitting, controlled limb movements. 2) Red Flags: Inability to prop sit and elbows in prone

Question 29

Between months 7 and 9 what characteristics should be present? What is a red flag at this age?

Answer 29

1) General Characteristics: Creeping/crawling, variety of play positions, exploring, NOT happy in supine, transitions sit-> quad and pull-> stand, cruising (lateral walking). 2) Red Flags: Content in supine, cannot sit indep.

Question 30

Months 10-12 will have what characteristics and red flags?

Answer 30

1) General Characteristics: Lowers from stand, increasing fine motor skills, cruising with one hand and rotation, indep. walking (9-15, usually 12)

Question 31

Give the two characteristics of the rolling progression for a 0-3 month old.

Answer 31

1) Non-segmental log rolling | 2) Neck Righting Reaction (Roll head and body comes in)

Question 32

How would a 4-5 month old baby progress their ability to roll?

Answer 32

Progress towards segmental rolling Supine--> Prone -supine--> sidelying (happy baby but looses balance) -sidelying--> prone with head righting reaction Prone to Supine

Question 33

What are the two stages and substages for rolling at 6 months?

Answer 33

1) Supine --> Sidelying a. Initiated with Flexion b. Neck: Neck to side c. UE are reaching, LE have hips flexed and ADD 2) Sidelying to Prone a. Neck: Lateral flexion and rotation b. Trunk: Lateral flexion then extension c. UE: reach with flexion then WS to free arm d. LE: Top leg flexes and ABD, then ADD; bottom leg is extended

Question 34

How would you find a one month old sitting?

Answer 34

``` Supported Neck: bobs a lot and not up very often Trunk: Very rounded LE: Frog Leg position Pelvis: Perpendicular to floor Pull to Sit: Significant Head Lag ```

Question 35

Name the changes from month 1 to month 2 in sitting.

Answer 35

Still supported Neck: Has a little more cervical extension Trunk: Still rounded Pull to Sit: Head lag, but want to visually fixate on the examiner

Question 36

How has the baby changed in month 3 of sitting?

Answer 36

1) Still supported 2) Neck: Steady, can keep a steady gaze, and with full support should heave head up 3) Trunk: Shoulders are in front of hips and scapulas are ADD. 4) Pull to Sit: No head lag at the end of movement

Question 37

What is the next stage of sitting for a 4 month old?

Answer 37

Less Support Neck: Full flexion/extend control Trunk: Upright with shoulders a little more over hips Pull to Sit: No head lag

Question 38

Give the characteristics for a 5 month old in sitting.

Answer 38

``` Prop sitting: hands keep them up (hands on floor) Pull to Sit Neck: Chin tuck UE: Pulls against examiner Trunk: Abs activated the whole time LE: Little bit of flexion at the end ```

Question 39

At 6 months old how should a baby be sitting?

Answer 39

Independent upright sitting Ring sitting (feet are together in a ring) UE free to play, but in high guard Pull to Sit: Full and anticipated rotation with sitting

Question 40

What would you expect to see for a 7 month old in sitting?

Answer 40

Steady with all trunk and UE motions UE: no more high guard with activity Trunk: Full rotation with protective extension Transitions: Sit prone via side sitting with some quad

Question 41

If a baby is 8 months old what would normal sitting be for them?

Answer 41

Stable and upright Transitions into and out of every position Equilibrium reaction: Keep body steady in nearly everything Protective Extension: helps with knocking down by sibling or outside factor ( full and bilateral)

Question 42

At 9 months old how should a baby be sitting?

Answer 42

Variable positions: Half ring, side sit, long sit, tall kneeling W sit: causes femoral anteversion (its ok with other sitting) Transitions: seamlessly and quickly Fine Motor Skills: Increase because they can sit with stability

Question 43

A baby sitting at 10+ months would exhibit what?

Answer 43

All righting/equilibrium reactions present and full | Spends lots of time in and out of sitting retrieving toys and transporting them to new location.

Question 44

The standing progression of a 1 month old would look like what?

Answer 44

Support at trunk Neck: head bob LE: Stiff because quads and HS are co contracting Automatic Step Reflex: Tip the baby and they step Positive support reaction: same as LE Physiological Flexion- but increased extension relatively in this position

Question 45

What would a 2 month old look like standing?

Answer 45

Supported at Trunk Trunk: Shoulders are anterior to pelvis Astasia: Lack of WB through LE Abasia: Lack of automatic stepping reaction

Question 46

At 3 months old how would a baby stand?

Answer 46

Supported at Trunk LE: WB a little with lots of hip & knee flexion, supported frog leg UE: High guard Plantar grasp Reflex: Curls toes with pressure

Question 47

What changes would you see from month 3 to month 4 in standing?

Answer 47

Supported at UE Neck: Full control Downward protective extension (LE only) LE: Still frog leg but taking more WB

Question 48

At 5 months old how would you find a baby standing?

Answer 48

Supported at UE LE: hips aligned with shoulders with full WB Pull to Stand: Comes all the way to standing

Question 49

At 6 months old how does a baby stand?

Answer 49

Supported at UE | LE: Bouncing but poor use of quads eccentrically

Question 50

7 month old babies stand how?

Answer 50

``` Pull to stand using UE at couch/bench More UE than LE No half kneeling WS: none or uses hands Poor eccentric use of quads ```

Question 51

8 month olds would be seen standing with what characteristics?

Answer 51

``` Pull to Stand: Emerging half kneel Increased dissociations and WS Emerging cruising- lateral stepping Steppage gait: not a lot of postural control LE: Wide BoS with ER and ABD Trunk: Not much rotation with walking ```

Question 52

When a 9 month old is standing what should you see?

Answer 52

Cruises on furniture Controlled lowering Still crawling and not walking

Question 53

At 10 months old what should standing look like?

Answer 53

Full ECC use of quads (lowering independently) Walks with HHA Leans belly on table/bench to reach with one hand (this is momentary) Up on toes/down on heels Squatting in play

Question 54

11 month olds should be standing how?

Answer 54

Half kneeling up and down with one hand Stands alone momentarily Cruises between surfaces Independent transition to stand

Question 55

At 12 months what would you expect to see in standing?

Answer 55

Independent ambulation (9-15 months) UE: high guard LE Swing phase: little DF, knee and hip flexion Stance phase: full foot hits floor, some triple ext. Waddling: wide BoS Quick Leg movements- frequent falls

Question 56

What types of things would you see with babies older than 12 months?

Answer 56

No new prone, supine, or sitting skills learned | Variability of gross motor skills based on standardized tests, authors, etc.

Question 57

What gross motor skills would you see for children 12- 15 months?

Answer 57

``` Assumes tall kneeling Assumes standing without support Stoops for objects while holding on to support Creeps up stairs Walks: stops, starts, and turns ```

Question 58

16- 18 month olds should show what gross motor skills?

Answer 58

Walks up stairs non-reciprocally with HHA (hand held assist) or railing Heel-toe gait, low guard Runs stiffly Stands on one foot with help Manages ride on toy and stand when changes clothes Carries large toy while walking ** Should not be creeping up stairs, but creeping down them is ok.