Postural Control and Motor Development Flashcards
Development of motor control
Primative reflexes
Postural reactions and fixations
Proprioception and vestibular/balance function
Visual function
Higher level skills
Neuromaturation
Sequence and rate of motor development that are consistent across typically developing children
Primative reflexes
Present at or just after birth and typically integrate in 1st year of life
May reemerge after brain trauma or injury
Purpose of Moro’s Reflex
Primitive fight or flight
Integration of Moro’s Reflex
Appears at birth and integrates by 2-4 months
Signs of retention: over-reactive, startles easily, poor development of head control, fearful of movement
Testing for Moro’s Reflex
Position child supine with head at midline
Quickly shift head position backward
Positive if child’s arms extend and hands open; then arms will flex and hands close; Infants usually cry
Purpose of rooting reflex
Automatic response to turn toward food (may not be present if infant is not hungry)
Integration of Rooting reflex
Appears at birth and integrates by 3-4 months
Testing rooting reflex
Position child supine
Lightly touch one side of face near mouth
Positive if infant turns head in direction of touch
Purpose of palmar grasp reflex
Lays foundation for voluntary grasp
Integration of palmar grasp reflex
Appears at birth and integrates by 5-6 months
Signs of retention: difficulty with fine motor skill development and precise release of grasp
Testing of palmar grasp reflex
Position the child supine
Place pressure on ulnar side of palm
Positive if fingers flex
Purpose of asymmetrical tonic neck reflex (ATNR)
Assist baby through birth canal and develop cross pattern movements
Integration of Asymmetrical tonic neck reflex (ATNR)
Appears at birth and integrates by 6 months
Signs of retention: Poor eye hand coordination, difficulty crossing midline
Testing of Asymmetrical tonic neck reflex (ATNR)
Position child supine with head in mid-position
Turn the child’s head to the side
Positive if arm and leg on face side extends and arm and leg on skull side flex
Purpose of spinal galant
Assist baby with birth process
Integration of spinal galant
Appears at birth and integrates by 3-9 months
Signs of retention: poor concentration, toileting difficulties, postural issues, often seen in CP
Testing of spinal galant
Position child in prone
Lightly stroke one side of spine
Positive if hips flex toward that side
Purpose of Tonic labyrinthine reflex
Basis for head management and postural stability
Integration of Tonic labyrinthine reflex
Appears in utero and integrates by 3 1/2 years
Signs of retention: poor muscle tone, toe walking, spatial orientation issues, impede activities that require trunk co-activation
Testing of tonic labyrinthine reflex
Position child in prone so that gravity pulls the child’s head into flexion
Positive if arms and legs flex toward chest
Position child in prone so that gravity pulls head into extension
Positive if arms and legs extend
Purpose of Landau reflex
Assist with posture development
Integration of Landau reflex
Appears at 4-5 months and integrates by 1 year
Signs of retention: poor motor development
Testing of Landau Reflex
Position child in prone
Positive if head extends
Purpose of Symmetrical tonic neck reflex
Preparation for crawling
Integration of Symmetrical tonic neck reflex
Appears at 6-9 months and integrates at 9-11 months
Signs of retention: slump while sitting, poor muscle tone, poor reciprocal movements for crawling/walking
Testing Symmetrical tonic neck reflex
Position child in a quadraped position
Flex child’s head
Positive if arms flex and legs extend
Extend head
Positive if arms extend and legs flex
Righting reactions
Allows infant to detect when body is not erect and causes head to move back into position
Appears at 7 months
Protective extension
Child extends hands to protect from a potential fall
Appears at 5-7 months
Equilibrium reactions
Maintains ability to keep center of gravity over base of support when an external force is applied
Appears at 6 months
Sensory integration
Process of receiving, organizing, and using sensory information
Developmental milestones
Specific markers to help track development
General progression of motor skill development
Control of static position
Vertical movement
Horizontal movement
Diagonal movement
Control of dynamic position
Transition between positions
Developmental patterns
Head to toe
Proximal to distal
Mass movements before specific movement
Why is playing in prone important?
helps develop balance, strength, coordination, and endurance
Newborn sitting skills
Head and center of gravity is forward
Lower extremities provide the base of support
Uses postural reactions to right head but unable to fully control it
Equilibrium reactions and protective extension become important for safety at 9-12 months
Crawling
Moving on belly by pulling forward with arms
Creeping
Moving on hands/knees with belly off ground
Importance of creeping and crawling
Strengthens core muscles
Visual perceptual development
Development of right and left brain
Body perception and spatial awareness
Provide independent means to explore and learn
Ankle strategy
Standing using our ankles and muscles that cross over the ankles to maintain balance
Stepping strategy
Present after 1-3 months of walking experience
Taking a step to compensate for a perturbation
Hip strategy
Seen at 3-6 months of walking experience
Moving our hips to maintain balance
Fine motor skill development
Reach
Grasp
Carry
Release (UE control is essential and grasp reflex must be integrated)
Early grasp progression
Palmar grasp
Radial palmar grasp
Radial digital grasp
Pincer grasp
Palmar grasp
Full hand grasp with all fingers excluding the thumb wrapped around the object
Seen at around 5 months
Radial palmar grasp
Grip using thumb to help hold object in hand
Seen at around 6 months
Radial digital grasp
Using the pads of thumbs and fingers as well as support from palm to grasp and hold objects
Seen at around 8 months
Pincer grasp
Using the tips of thumb and index finger to pick up objects
Seen at around 10 months
Grasp patterns
Tip pinch
3 pt pinch
Lateral pinch
Spherical
Cylindrical (holding a cup)
Disc (opening a jar)
Hook (like holding a purse)
Power
Prerequisites for in-hand manipulation of objects
Ability to control arches of hand
Forearm supination
Isolated finger and thumb movement
Thumb opposition
Wrist stability
Disassociation/differentiation of radial and ulnar side of hand
Finger-to-palm translation
Ability to move object from fingertips to hand
Palm-to-finger translation
Ability to move objects from palm to fingertips
Shift
Ability to move object between fingers
Ex. Trying to separate two pieces of paper that are stuck together
Simple rotation
Ability to roll a small object between thumb and finger tips
Ex. Using fingertips and thumb to open a small jar
Complex rotation
Ability to turn an object end over end
Ex. Flipping a pencil over in one hand to use the erase
In-hand manipulation with stabilization
Performing a shift or rotation while also holding an object with the hypothenar aspect of the hand
Palmar supinate grasp
Fisted grasp with thumb wrapped at the top of pencil
1-1/2 years
Radial digital grasp
Fingers from middle and thumb grasp pencil
2-3 years
Modified tripod grasp
Pads of all fingertips hold pencil (4th and 5th digit do not tuck)
3 1/2 -4 years
Tripod grasp
Using the tips of fingers on writing utensil at an angle with 4th and 5th fingers tucked into palm
4 1/2-7 years
Bilateral integration
Allows child to coordinate movement of two sides of body
Progression of bilateral integration
Symmetrical patterns dominate initially
Bimanual actions emerge in 10-12 months
Reciprocal and alternating hand movements
Simultaneous manipulation
Differently uses two hands
Progression of cutting skills
Snips paper at 24 months
Cuts across paper without a line
Cuts on line
Cuts circle
Cuts square
Cuts triangle
Cuts complex shapes (5-6 years)
Prerequisites to movements crossing the midline
Increased mobility
Increased anti-gravity stability and movement
Increased weight shifting
When is stable hand preference established?
By 5 years
Gross motor milestone at 3 months
Symmetrical UE and LE movements
Sits with head control in supported sitting
Props on forearms when in prone
Holds head at 45-90 degrees in prone
Rolls from tummy to back
Fine motor skill milestones at 3 months
Visual tracks person or object
Grasps rattle momentarily
Brings hands to midline
Begins to reach for objects
Gross motor milestones at 6 months
Prone on extended arms
Pivots in prone
Feet to mouth
Rolls back to tummy
Sits independently
Stands with support
Fine motor milestones at 6 months
Transfers object from one hand to the other
Brings toys to mouth
Reaches with one arm
Bangs objects on table
Gross motor milestones at 9 months
Up on hands and knees
Crawls
Transitions from sitting to prone
Transitions into sitting
Pulls to stand
Cruises on furniture
Fine motor milestones at 9 months
Reaches toys in sitting without falling over
Claps hands
Bangs 2 cubes together
Shakes, bangs, throws, turns page in book
Pokes with finger
Takes object out of container
Gross motor milestones at 12 months
Efficient with creeping
Stands unsupported momentarily
Takes first steps independently
Fine motor milestones at 12 months
Finger feeds self
Points with index finger
Puts 3 or more objects into a container
Gross motor milestones at 15 months
Walks independently
Squats without support to retrieve object
Walks up and down stairs with hands held
Flings ball forward
Fine motor milestones at 15 months
Stacks two 1 inch cubes
Assists with undressing
Marks paper with crayon
Gross motor milestones at 18 months
Walks efficiently
Walks up and down steps holding railing
Climbs into adult chair
Fine motor milestones at 18 months
Builds 3 block tower
Scribbles on paper
Bilateral coordination: one hand holds, one manipulates
Places pegs in board
Gross motor milestone at 24 months
Runs
Jumps in place, 2 feet off ground
Walks up/down stairs without railing
Throws overhand
Fine motor milestones at 24 months
Strings 1 inch beads
Snips with scissors
Draws vertical line
Circular scribbles
Puts shoes on
Uses spoon and fork
Gross motor milestones at 3 years
Kicks ball without help
Walks up stairs alternating feet
Rides tricycle
Fine motor milestones at 3 years
Copies a circle
Imitates cross
Completes simple puzzle (3-5 pieces)
Unbuttons 1 inch buttons
Gross motor milestones at 4 years
Catches ball with hands
Rides bicycle with training wheels
Stands on one foot for 6 seconds
Hops on one foot
Jumps forward
Fine motor skills at 4 years
Draw person with 3 parts
Builds 8 block tower
Cuts following line
Static tripod grasp
Gross motor milestones at 5 years
Efficient with walk, running, and climbing
Skips
Walks downstairs holding object
Throws ball at target
Walks downstairs reciprocally
Fine motor milestones at 5 years
Copies square and triangle
Copies name
Dynamic tripod grasp
Cuts simple shapes
Prints some letters
Draws person with 5+ body parts
Established hand dominance
