Typical vs Atypical Motor Development

Question 1

What is the key to normal motor development for a child?

Answer 1

Variability of Movement

Question 2

Gives the planes of control in the sequence that they are acquired.

Answer 2

Plane 1: Sagittal (Flexion/Extension)
Plane 2: Frontal (Head righting reaction)
Plane 3: Transverse (Rotation for rolling)

Question 3

What are the 3 directions of normal development?

Answer 3

Cephalic->Caudal
Proximal->Distal
Total Body synergies->dissociated motor patterns and individual movements

Question 4

Give some examples of the total body synergies->dissociated motor patterns and individual movements.

Answer 4

1. Kicking reciprocally-> reciprocal walking
2. Reaching with UE without LE moving
3. Neonate individual movements-> purposeful individual movement

Question 5

Abnormal development is the absence of what?

Answer 5

Variability and adaptability

Question 6

Name the plane where atypically developing kids “get stuck”. What are two consequences of that?

Answer 6

Sagittal plane; difficult to grade flex/ext against gravity and failure or delay of righting and equilibrium reactions to emerge

Question 7

What 5 things are different with atypical developing kids in regards to their direction of development?

Answer 7

1. Cephalic-> caudal (stays the same)
2. Lack of inhibitory control
3. Synergic motor patterns continue
4. Exaggerated reflex behavior
5. Select movements can’t be executed

Question 8

When would you determine that a child was atypical?

Answer 8

When they started to assume more upright positions

Question 9

Why is it easier to pick out an atypically developing child once they start developing?

Answer 9

Because they are starting to move more, their bodies are getting bigger, and their muscles and bones aren’t developing correctly

Question 10

Normal prone development includes what movements?

Answer 10

Antigravity movements
Extended arms
Dissociation
Weight shifts

Question 11

What would a hypotonic child look like in prone? A hypertonic child?

Answer 11

Hypertonia: Extensor hypertonicity OR flexor synergies, ATNR persists, Indwelling thumb persists, shoulder elevation, poor shoulder girdle stability, and scores well on standardized exams up to 4 months.

Hypotonia: Inability to lift head, hinging, shoulder elevation, poor shoulder girdle stability, and poor dissociation.

Question 12

Normal supine development of a child will look like?

Answer 12

Flexion against gravity, midline orientation, knees/feet up, hands to feet, bridging controlled in play

Question 13

Give the two types of abnormal development for a baby in supine.

Answer 13

Hypertonia: Pelvis anteriorly tilted, UE and shoulder girdle retracted, postural asymmetry persists (ATNR)-lateral curve of spine, persistence of primitive reflexes

Hypotonia: Poor antigravity flexion, LE flexed and wide ABD (frog leg), poor abdominal control (feet and legs not in visual filed), may develop extensor hypertonicity later (>5 yo), and sinking into gravity

Question 14

What would be considered normal for side lying development?

Answer 14

Lateral righting of cervical spine and trunk
Muscle balance- abs and back
Head in midline
Arms to midline

Question 15

Give the abnormal development for side lying.

Answer 15

No lateral righting
No muscle balance- therefor usually flop to belly or back
Increased cervical and trunk extension in children with hypertonia

Question 16

Normal rolling development includes what?

Answer 16

Normal initial attempts are initiated by pushing into extension
Segmental rolling with lateral head righting bilaterally at 6 months

Question 17

Atypical rolling development will look like?

Answer 17

Hypertonia: supine to prone push through extension then flop (not segmental), prone to supine harder (spastic hemiplegia push with 1 UE to flip to back)

Hypotonia: Rare that they will roll, MAYBE at a 1 y.o.

Question 18

What would normal sitting development look like?

Answer 18

Pelvis Perpendicular
Prop sitting or high guard (5-6ish months)
Coordinated flex/ext at hips and trunk
Protective Extension and equilibrium reactions at 7-8 months
PTS with active flexion at 5-6 months

Question 19

How would you find an atypical child sitting?

Answer 19

Hypotonia: lack of ext against gravity, trunk forward with hinging with cervical spine hyperext., wide ABD of hips provide stability, PTS: head lag into 1st year of life

Hypertonia: Spine ext (premature) with high guard, sit on sacrum, PTS: appears to be helped by using tone and co-contraction)–This looks advanced but isn’t because it is not volitional

Question 20

How would an older child atypically developing try to sit?

Answer 20

Patterns changes as child ages, compensation for lack of mobility and stability, W sitting common, Tight hip and back extensors cause posterior pelvic tilt- sacral sitting, long sitting: hip ADD, posterior pelvic tilt and PF

Question 21

Normal creeping includes what types of movements?

Answer 21

Lateral wt shifting practice in prone and sitting—- Lateral trunk righting
Stability through wide BoS (ABD, ER)
Trunk Rotation and equilibrium reactions narrow support
Dissociation for LE for reciprocal creeping

Question 22

Pick one of the two atypical developments for creeping from the given information: Less motivated that other children, poor trunk control-swayback, transition through W sit or full ABD (splits), crawl short distances (easily fatigued), very delayed (over 1 y.o.)

Answer 22

Hypotonia

Question 23

A hypertonic child would creep how?

Answer 23

Same motivation as typical children, commando crawling (UE pull, legs and stomach drag, hips ADD IR and PF), Spastic diplegia (bunny hopping)

Question 24

The normal standing development of a child looks like?

Answer 24

Supported standing with wide BoS (ABD, ER)
Rotation components emerge 
Indep. amb. with wide BoS 
Pelvic rotation emerges 
1/2 kneeling to pull to stand 
Always refining balance and posture

Question 25

What would an atypical child look like in standing?

Answer 25

Hypertonicity (untreated): PF- WB on ball of feet only, Flexion ADD IR at hips (crouched posture), poor BoS, CoM not aligned over BoS, no dissociation or 1/2 kneeling.

Hypotonia: If they stand– WB on heels with curled toes and DF, Wide ABD and ER, wt shift to medial side of foot-excessive pronation, lacks active hip ext. and pelvic control.

Question 26

What is normal horizontal suspension?

Answer 26

Antigravity extension and alignment, variety of movement of UE and LE

Question 27

What would atypical horizontal suspension look like?

Answer 27

Hypertonicity: Increased extension of entire body without variable movements of UE and LE, feels stiff in your hands.

Hypotonicity: Poor antigravity extension of trunk and head, little movement of UE and LE due to poor trunk extension.

Question 28

What would protective extension look like in a typical child?

Answer 28

Forward movements of both arms, head in midline, normal progression

Question 29

An atypical child would look like what during protective extension?

Answer 29

Poor antigravity alignment, Delay or absent forward movements of arms to floor because they don’t get head or equilibrium reactions.