Typical Development - Posture Flashcards
newborn is dominated by
physiological flexion and lack of anti-gravity mm control
30 degree contracture at hips/knees
excessive dorsiflexion
newborn: prone
UE flexion, hands fisted
LE flexion, high pelvis
Head: turned to one side
describe the LE in a newborn in supine
flexion, abduction, external rotation
new born has a positive head?
lag
spine of a newborn
flexion throughout entire spine, flexed at hips
newborn: sitting
head will drop “forward” bc still no anti-gravity mm (extensors)
one month: prone
UE
LE
Head
less UE and LE hip flexion
more anterior pelvic tlit
head: able to lift head momentarily
one month: supine
UE
LE
Head
UE: some reaching, hands still fisted
LE: reciprocal and symmetric kicking
Head: turned to one side (still no anti-gravity flexion)
pull to sit is more pronounced at
1 month
supported sitting at 1 month
head forward still, and no anti-gravity trunk extension
Primary standing / positive support
one month
integrated by?
bears weight on exteded leg
integrate 1-2 months
stepping/automatic walking integrated by
3-4 months
characterisitcs of a 2 month old
less flexion dominance, increased extension,
asymmetry (ext/flex not yet balanced)
prone: 2 months:
UE
LE
Head
UE: more shoulder abduction
LE: pelvis closer to surface
Head: able to lift 45 degrees
in prone, 2 month old mainly WB on?
elbows (elbows are behind shoulder)
2 month: supine
UE
LE
Head
UE: shoulder ER increased
LE: decreased hip flexion, abduction, ER
head: increased neck rotation
Important reflex appears at 20 weeks, and integrates at 4-6 months?
ATNR
you will see a continued head lag and flexion throught the spine at
2 months
2 month old during supported sitting: will start to see
intermittent head and neck extension
but still flexion throughout spine; no anti-gravity trunk extensin yet
postitive support/primary standing at 2 months:
WILL NOT ACCEPT WEIGHT; it’s integrated.
Baby will have poor orientation of feet and appear with motor incoordination
automatic walking/stepping reflex at 2 months
MAY be integrated…
integrated by 3 to 4 months
3 Months characteristics
- symmetry (balanced control of neck flexion/extension)
- midline orientation (head, eyes, UE)
- body awareness: hands together (on feet,chest)
3 months : prone
UE
LE
Head
UE: increased abduction
LE: hip extension, abduction, ER
pelvis flat, knees flexed, feet together
Head: able to lift head 90 degrees
**upper trunk extension **
where does a 3 month old mainly WB?
forearms (elbow in line with shoulders)
3 months: supine
UE
LE
Head
UE: hands together, resting in midline on chest, SOME reaching
LE: hip and knee flexion, abduction, some ER, heels togeter
Head: in midline
decreased neck rotation and ATNR by
3 months
importnat head feature in a 3 month old?
chin tuck
neck flexor activity
head righting
baby in vertical position, tilt slowly to the side will cause baby to move the head to the vertical position
will see trunk flexion C/L
When is head righting strongest?
3 months
(present at birth)
3 months: pull to sit
asymmetric head lift (flex/extensors working inconsistently)
3 months: sitting
head: midline
UE: shoulder elevation and upper cervical extension
flexion still throughout the spine, not enough trunk extension
3 months: standing
hips
knees
toes
accepting some weight on feet again
hip : abducted
knee: still in extension
toes: curled (plantar reflex)
reflex integrated at 3 months
automatric walking
4 months characteristics
- symmetry and balance (ext/flex are controlled)
- good head control
4 months: prone
scapula
hips
what is lifted?
scap: adduction with trunk extension
hips: extension and adduction ;
INCREASED ANTERIOR PELVIC TILT AND LUMBAR EXTENSION
head and chest lifted (upper turnk extension)
at this age, baby may accidently roll into sidelying
4 months
4 month: primarily WB on
forearm (elbow close to body)
4 months: supine
baby reach above body in midline
increased pelvic tonrol (PPV w/ hands to knees)
head in midline
pull to sit 4 months?
no head lag!
assist to sit with upper chest and UE flexion; overflow to abdominals and LEs
4 months: sitting
- Head in midline
- Holds head steady in supported sitting
- Flexion at hips
- Curved spine below point of upper trunk extension
symmetrical tonic neck reflex: what is it?
head flexion: arm flexion, hip legs
head extension: arm extension, hip legs
onset and integration of STNR
onset: 4-6 months
integrated: 8-12 months
4 months: standing
more weight on LE
PT can hold by hands instead of chest
pelvis behind shoulders
LEGS MAY FLEX OR EXTEND
5 months: overview
beginning of lateral wt shifts and lateral righting of head/trunk for postural responses to emerge at 6 months
5 months: prone
arms
hips
head
- Extended arm weight bearing,
- hip extension, adduction, neutral rotation
- head and upper trunk lifted
“swimming”
in 5 months: total spinal extension, movement of upper and lower extremities
where is the weight shifted during reaching with a 5 month old?
forearm
five months: prone reaching
WB side
reaching side
WB side: hip extension, adduction, IR
reaching side: hip hike, hip flexion, abduction, external rotation
develoment of LE dissociation occurs when?
5 months
May roll prone to supine
5 months
5 months: supine
full shoulder flexion / adduction , elbow, wrist, and finger extension
HANDS TO FEET
Increased pelvic control, posterior pelvic tilt with feet to hands and mouth
Asymmetrical rolling to sidelying
- Upper and lower extremity dissociation
five months: sidelying
lateral flexion of head away from floor
elongation of WB side
5 month: sidelying
bottom leg
top leg
bottom leg: extended and adducted
top leg: flexed and abducted
five months: pull to sit
- NO HEAD LAG
- increased abd control and LE flexion
- hold head in line w/ body
- assist w/ upper extremity needed
- ovten will pull to stand
5 months: sitting
head in midline
flexion at hips, propping on arms, or “high guard” position to stabilize
5 months: standing
knee
hips
lumbar
knee extension, plantar flexion
hip abduction and ER
hips almost in line with shoulders
lumbar lordosis
- may pull to stand
6 months overview
what emerges? etc
- good head control in all directions
- increased shoulder girdle control
- mature landau response
- prone equilibrium reactions emerging in supine
- postural responses emerge
landau response
prone, horizontal suspension, the head will rise above trunk and extremity extension
flexing the head will cause hip flexion
landau reflex
when does it emerge? how long does it last?
emerge: 3-5 months
lasting: 12 months
six months: prone
- reaching forward with weight shift
- less anterior pelvic tilt and more control
matured swimming is accomplished at
6 months
head and upper trunk lifted; elbow, wrist, and finger extension
at 6 months this stability develops
shoulder girdle stability
6 months: supine
reach bilaterally and can transfer objects from 1 hand to another
- more pelvic control
- asymmetrical rolling to prone
- upper/lower extremity dissocation
head: chin tuck
six months: pull to sit
independent
back is straight, PPT, hip flexion/abduction/ER
upper extremity used for reaching and manipulating
anterior protective extension starts at
6-9 months
which protective extensions emerge first?
anterior
emerges after anterior protective extension, also emerges 6-9 months
lateral
six months: standing
able to stand with less support (holding fingers)
- FULL WB (ok to lock knees)
- hip abd
- bounces up and down w/ feet on floor
- increased abd control and hip extensors
seven months: overview
- variety of movements
- very active against gravity
- little time spent in supine
seven month: prone
quadruped rocking
belly crawl
prone pivoting
seven month: supine?
doesn’t like supine, wants to explore so will roll out of it
seven months: sitting
trunk rotatation in sitting (can sit from quadruped)
lordosis
will transition STS
equilibrium precarious
seven month: sidelying
frequent playing in sidelying
good lateral righting
seven months: standing
full WB, min support
pull to stand
bounces
UE parachute
prone horizontal suspension at chest move child toward surface head first- symmetrical arm extension and abduction
when does UE parachute emerge?
6-7 months
8 months: overview
quickly moves to diff positions
explorative
play in supported standing/kneeling
8 month: prone
hands and knees (primary mode of locomotion “crawling”)
transition QP to sitting - uses lateral righting
8 month: sitting
trunk extension good
DC LE stability
rotation counter balanced by sideward protective extension or equilibrium reactions
sitting to quadruped
sitting to quadruped
8 months: standing
pull to stand (from kneeling or 1/2)
rotates trunk
cruises sideways
standin with one hand help (min a)
steppage gait
9 month: overview
versatile sitting
crawling primary means for locomotion
drive to stand and walk
9 months: sitting
be aware of ‘W’ sitting
increased trunk control; various LE positions
9 month old increases hip mobility by
side sitting
posterior protective extension
in sitting, gently push backwards.
arms will extend back to prevent fall
(last protective reaction to emerge)
posterior protective extension onset?
9-11 months
anterior righting
pull backwards at shoulders- arms and head will reach forward to recover balance
when does anterior righting emerge?
9 months
9 month: kneeling
incomplete hip extension
may move into half-kneeling to play
nine month: standing and curising
pull to stand using UE
(LE more active going thru half kneeling)
standing “cruise” around furniture
semi-turning in direction to which he is going
nine month: supported walking
walking w/ 2 hand held
D/C LE abduction and ER
UE fixing for support
ten month:
exporation and motor skills practice
play in-and-out games with containers
ten month: sitting
able to long sit
sit for stability and can easily transition to other positons (hip flex/abd/ER)
10 month: standing
rise thru kneeling/ or half
lower self from standing and maintain UE support
reaching for toy witho one hand
10 month: supported walking
walk w/ 2 hand held
starts to use some pelvis rotatio and more LE stride
marked trunk extension
11 month: overvieew
bi manual activity
beginning of independent standing
gross motor skills for container play
11 month:sitting
controlled trunk rotation
increased hip control: able to use kneeling and half kneeling more frequently
11 months: standing
stands alone (UE use limited)
wide BOS
cruises and reaches for furniture out of reach
11 months: walking
may attempt unsupported walking
**UE fixing
steppage gait with ER **
12 month: overvierw
righting reactions well integrated in most movements
all basic motor skills present
12 months: equilibrium reactions should be present in all positions except?
standing
12 month: sitting
engaged in playing in sitting (variety)
easily move in and out of all positions
12 month: standing
rise from floor w/ leg (no UE)
**able to weight shift **
12 month: squatting
for play
able to take steps, stop and squat to pick something up, and keep walking
12 month: unsupported walking (may attempt)
trunk extension, scap adduction, wide BOS
