Child Development Cb: Unit 3 Lesson 2/ 4 "Gross Motor Development"

-use the hands -cervical extensors

When external support is removed, the trunk will collapse forward as in the 1 month old. However, the 2 month old will be able to _____ to prevent the trunk from falling as far forward as before. Also, the 2 month old can use the _____ to help lift the head so the face does not come to rest on the support surface.

2 month

Which month is referred to as the 'Asymmetrical Period'?

3 month

Which month is referred to as the 'Symmetrical Period'?

1. True 2. True

1. True or false: A 1 month old may begin to demonstrate the ATNR when at rest. 2. True or false: A 2 month old has increased cervical rotation as compared to a 1 month old. Therefore there is increased possibility for stimulation of an asymmetrical tonic neck reaction (ATNR).

1. 2 months 2. Since 2 month old infants readily assume and ATNR when placed in supine at 2 months of age, this is referred to as an "asymmetrical period." 3. Asymmetry in a 2 month old is normal.

1. What month is labeled "Asymmetrical Period"? 2. Why does this month have that label? 3. Is the asymmetry a normal or abnormal finding?

1. midline 2. symmetrical 3. ATNR 4. Frog leg = FABER + Knee flexion / hip flexion, abduction and external rotation with knee flexion

3 Months, Supine: -At 3 months in supine the infant will begin to develop ___1___ head control ; will begin to demonstrate a chin tuck through the activation of the cervical flexors. -Referred to as the ___2___ period. -An infant 3 months or older who continues to exhibit the ___3___ reflex and doesn't appear symmetrical: may be a sign of neurological / developmental issues. -Positions the lower extremities in frog leg position, describe this position (4). -Infant will frequently bring the hands together in midline; bring feet together -Infant may start to use shoulder flexion and internal rotation to lift the arm against gravity.

1. high guard position

3 month: Sitting 1. Will be able to keep the head up in midline. 2. Will be able to balance the head over the trunk -indicates use of both cervical flexor/ extensor muscle groups. 3. Will use shoulder elevation to help stabilize the head in the upright position and will be able to rotate the head to view the environment. 4. Increased extension through the upper portion of the thoracic spine 5. If external support taken away from the infant's hands and moved to the pelvis: infant's arms will move into the _____1_____ . Will need this position to increase the thoracic extension to help keep the trunk upright. 6. If the external support is removed entirely the infant will still collapse forward. Can keep head farther away from support surface b/c cervical extensors getting stronger

1. prone on elbows 2. infant's nipples 3. in line 4. the forearms 5. 90° 6. flexion, abduction and external rotation

3 months, prone: 1. The infant will assume a very important position called _____ . 2. In prone, the COG and weight moves posteriorly which allows the head and upper trunk to move farther away from the support surface. Now the weight is borne at about the level of the _____ . 3. Elbows have moved forward and are now _____ with the shoulders instead of behind the shoulders. 4. The infant is now able to bear weight on _____ which help to lift the upper trunk off the support surface. 5. Infant will be able to lift the head up into extension so that the face is _____ ° from the support surface. Not only can the child keep the head up for extended periods of time, the infant can also rotate the head and visually scan the environment in this position. 6. While the legs have moved more toward extension, realize that the hips are still positioned primarily in _____ .

elevate the shoulders

3 months: Pull to Sit 1. less head lag during PTS 2. may attempt to activate cervical flexors during PTS. though may not be symmetrical- head may rotate to one side. 3. Infant will __________ to help stabilize and support the head in midline. This can be seen in Fig. 3.11.

2. pec major; sliding away from the body 4. anterior 6. in front of the ; behind the ; between the scapula and humerus ; scapulo-humeral dissociation 7. abduction and external rotation 8. pelvic weight shift 9. pivot prone ; Landau reaction 10. optical and labyrinthine 11. extensor ; weight bearing ; in ventral suspension

4 Months: Prone 1. Spend a lot of time in POE with forearm weight bearing, face up 90° from support surface. 2. Increased use of upper trunk flexors especially _____2_____ : allows chest to be more elevated from support surface which prevent elbows from _____2_____ into abduction. 3. Pelvis almost to support surface, beginning to see extension to the lumbar spine. 4. Hips still have some physiological flexion: pelvis will have ____4____ pelvic tilt. 5. Less likely to have accidental roll b/c better able to stabilize the shoulder in response to a face-side weight shift 6. Elbows may have moved ____6____ shoulders when seen from a lateral view. Remember that in the neonate, the elbows were ____6____ shoulders. As this progression of the elbow has occurred, it has allowed for elongation of the muscles ____6____ . This elongation is necessary to develop ____6____ . 7. Infant has narrowed the BOS by decreasing the lower extremity ____7____ and ____7____. 8. The pelvis is closer to the support surface and the BOS is more narrow: kicking in this position may result in a ____8____ : this can cause an accidental roll into side lying or supine. Rolling from the prone position is still primarily accidental. 9. Will begin to demonstrate the ____9____ position: the infant adducts the scapulae and lifts the arms from the support surface, will use trunk extension to keep upper trunk off support surface. This position is similar to the ____9____ ; an indication of the degree of antigravity extension through the head/neck and trunk. 10. The Landau reaction is assessed with the infant in ventral suspension and is driven by the ____10____ righting reactions. 11. The pivot prone position requires a significant amount of antigravity ____11____ activity. 12. The pivot prone position and the Landau reaction are essentially the same except pivot prone position = _____12_____ ; Landau reaction _____12_____ .

1. in midline with a chin tuck 2. -------- 3. extended ; remain on ; flexed ; flexed

4 Months: Pull to Sit 1. The head is ____1____ prior to the PTS. 2. There may be minimal head lag at the beginning of the movement, but the head will be pretty well kept in the same plane as the trunk. 3. Prior to 4 months, when the infant was pulled to sit the arms would be ____3____ at the elbow and the legs would ____3____ the support surface. Now, the infant increases the antigravity flexor activation of the arms and legs as though the infant is attempting to help pull itself into sitting: ____3____ legs and ____3____ elbows.

1. accidental 2. flexed 3. unilateral neck 4. unilateral flexors and extensors

4 Months: Sidelying 1. Infant will roll supine to sidelying- ____1____ . 2. Legs are ____2____ when the infant rolls into sidelying: blocks roll from side lying over into prone. 3. Infant will spend some time in side lying: lateral head righting, requires the use of ____3____ flexors and extensors. 4. This is the first time the infant has coordinated the use of ____4____ ; have new level of developmental control.

1. thoracic 2. the arms will move into the high guard position. 3. external stability is provided 4. Extension; The infant will not demonstrate protective extension reactions because they have not yet developed. 5. Ring sitting (legs closer to support surface due to increased hip mobility)

4 Months: Sitting 1. Once in sitting, head will be up, trunk is extended down through the ____1____ region. 2. If external support removed from baby's hands: ____2____ . 3. Weight shifts the infant cannot control will cause the infant to fall out of sitting unless ____3____ . 4. If the infant falls out of sitting (d/t uncontrolled anterior weight shift) will they demonstrate protective _____4_____ reactions? 5. ____5____ gives wider BOS for sitting. *Baby tends to bring mouth to toy -> anterior weight shift and loss of balance in anterior direction.

1. chin tuck 2. trunk flexor ; flexors 3. abdominal muscles 4. the arches of the hands 5. anterior pelvic tilt and the lumbar extension 6. pelvic mobility

4 months: Supine 1. Head held in midline with a ____1____ . 2. Increase in ____2____ activation: ____2____ will start to balance the extensors. 3 Hands and legs together in midline; infant will position the legs in space over the trunk. This requires use of the ____3____ to stabilize the pelvis. 4. Begin to visually take notice of the knees and will bring the hands to the knees. This hands-to-knees activity is a part of body exploration and it will also help to form ____4____ . 5. Legs in space = posterior pelvic tilt.; infant extends the legs = anterior pelvic tilt. With the infant's feet in contact with the support surface, the infant will push the legs against the support surface and increase ____5____ . 6. Interplay between leg flexion / posterior pelvic tilt and leg extension against the surface / anterior pelvic tilt helps develop ____6____ .

1. prone on hands (POH) ; trunk extension 2. down on ; the lumbar lordosis 3. elongation 4. 2 ; antigravity 5. will not 6. adduction ; decrease ; facilitate 7. Landau reaction ; Righting ; 8. No, it has not extended down into the hips and lower extremities

5 Months: Prone 1. Achievement unlocked: _____1_____ . This position increases _____1_____ . 2. Pelvis is _____2_____ the support surface the increased trunk extension will help to increase _____2_____ . 3. POH important to complete the _____3_____ of the abdominal muscles. 4. Elongation of abdominal muscles began at _____4_____ months (head was up 45° from the support surface) and continued with POE at 3 months. The infant's chest was lifted up more at 4 months from the use of the upper chest flexors (pec mjr) and the moved farther up at 5 months with POH. This progression is important for normal activation of abdominal muscles: if this progression did not occur the infant would not achieve good activation of the trunk flexors for good _____4_____ trunk activity. 5. Shoulder ___ will / will not ___ collapse during weight shifts as it did at 4 months. 6. Legs have moved into more _____6_____ at the hips to _____6_____ the BOS and _____6_____ weight shifts. 7. Infant demonstrates more extension in pivot prone. Remember, this is the equivalent of the _____7_____ which is triggered by the _____7_____ reactions. 8. Can lift the head, arms and upper trunk off the support surface with antigravity trunk extensors. There is significant extensor activation of the head/neck and trunk, has it descended to LEs yet?

There is the beginning of a cervical lordosis ... The head will still be primarily flexed forward but the infant will occasionally attempt to lift the head with little phasic bursts of the cervical extensors. The infant will extend the head but will not be able to lift the head up far enough to be in line with the trunk and then the head will fall forward again = bobbing.

A 1 month old will demonstrate some bobbing of the head in supported sitting. Why?

Yes they are able to.

Are babies able to move out of the ATNR at 2 months?

gravity

At 2 months, in supine, _____ has played a major role in increasing shoulder external rotation

1. Not enough shoulder stability to counteract head movements 2. ATNR In the POE position with the head up so the face is 90° from the support surface, the infant will rotate the head to view the environment. As this happens, the infant may shift the head too far over the face-side shoulder. The shoulders have not yet developed sufficient stability in the POE position to withstand this increased weight on one shoulder. The inability of the shoulder to stabilize the position will cause the infant to fall toward the face-side shoulder and roll into side lying.

At 3 months of age, the infant may accidentally roll into a side lying or supine position (from prone). Why? (2 reasons)

45°

By 2 months of age, the infant will be able to lift the head up into extension so that the face is ____ ° from the support surface.

No

Does a 1 month have sufficient control of either the head, trunk, or hip extensors to keep the head or trunk upright against gravity?

-Standing: lowers self to sitting while holding onto furniture, stands with 1 hands held -Creeps up/down stairs -Kneels without support

Gross Motor Milestones: 10 Months

-Cruises -Walks with 1-2 hands held -Stands independently -Transitions: squat to stand or quadruped to ½ kneel to stand -Plays in squat position -Climbs down off of furniture -Lowers self from sitting to standing through ½ kneel -Uses rotation during sitting or standing

Gross Motor Milestones: 11 Months

Takes 5 steps independently Creeps on hands and knees rapidly Plays in ½ kneel Comes to standing via squat without pulling up on furniture Seats self in child sized chair Lowers self backwards off of furniture Lowers self from standing to sitting without holding on

Gross Motor Milestones: 12 Months

-Hands usually open -PTS: no head lag, anticipates being picked up - feedforward -Prone: pivots on belly -Rolling: back to side with flexion -Supported sitting: good head control, slight spinal flexion, may prop briefly -Supported standing: takes weight briefly, good head control, active quads but no grading, pronates ankles, curls toes.

Gross Motor Milestones: 4 Months

-Supine: lifts head to be picked up, feet to mouth and hands to feet -Prone: up on elbows for long periods and reaches for toy, weight shifts in prone on extended arms -Supported sitting: full spinal extension, good head control, grasps objects while sitting, briefly props -Rolling: prone to supine -Supported standing: takes almost full weight, bounces when held in standing

Gross Motor Milestones: 5 Months

-PTS: initiates cervical flexion - feedforward -Supine: lifts legs high against gravity -Prone: on extended arms with hands open -Supported standing: bears all weight -Sitting: ring sits independently -Rolling: prone to supine and supine to prone -Quadruped: assumes this position -Stranger anxiety begins

Gross Motor Milestones: 6 Months

-Prone: reaches for toy while prone on extended arms -Sitting: sits independently -Standing: pulls to standing through squatting or ½ kneel, bounces, can't lower self when standing at furniture -Kneeling: kneels at furniture -Quadruped: rocks in quadruped Bear walks

Gross Motor Milestones: 7 Months

-Separation anxiety (6-18 months) -Dislikes supine -Sitting: good balance, side sits -Transitions: prone to sitting to prone -Commando crawls on belly -Pulls to standing -Climbs onto furniture and stairs with no regard for safety

Gross Motor Milestones: 8 Months

-Sitting: ring sits, long sits, side sits, transitions into and out of sitting, reaches for toys outside of base of support, sits independently x10 minutes -Creeps on hands and knees -Transitions: sitting to quadruped to sitting, standing to sitting accidentally -Creeps up stairs but not down

Gross Motor Milestones: 9 Months

-PTS (pulled to sitting): complete head lag -Supine: displays ATNR, random movement -Prone: turns head, lifts head briefly -Sitting: supported, attempts to right head, unable to sustain head control >1-2 sec

Gross Motor Milestones: 1 Month

-Physiological flexion resolved ie full AROM -Eyes cross intermittently -Supine: head rarely in midline, thrusts arms and legs, kicks legs reciprocally -Prone: head in midline, holds head up 45 degrees, tries to WB on UEs but elbows behind shoulders -Sitting: poor head control, bobs head -Rolling: side to back -Standing: abasia, astasia

Gross Motor Milestones: 2 Months, Asymmetrical Period

-Supine: head in midline, symmetrical kicking -Prone: attains prone on elbows with head and trunk up without bobbing -PTS: initial head lag, lifts head when closer to sitting -Supported sitting: good head control -Supported standing: abasia/astasia gone

Gross Motor Milestones: 3 Months, Symmetrical Period

-Physiological flexion -Hands fisted -Supine: head to side -Prone: weight on head, can lift and turn head -Supported sitting: complete head lag, spine rounded

Gross Motor Milestones: Newborn

Prone, Supine, Side lying, Sitting, Quadruped

Gross Motor Skills Progression

2 months

In context of prone position: At ____ months a baby's weight is shifted farther back so that the weight is now on the upper trunk instead of the baby's face?

1. 2-month-old. 2. Because the head is to the side/ more to the side.

In context of supine position: 1. Lateral vision becomes dominant where eye-hand regard (looking at one's own hand) and uncontrolled swiping at toys at the baby's side is frequently observed in the __________ month-old. Why is this?

In sitting, high guard is a combination of scapular adduction and shoulder abduction and external rotation a baby uses to help increase thoracic extension. It's a compensation to increase thoracic extension in positions where the infant has not yet developed sufficient strength

In our notes, the first time 'high guard' is mentioned is at 2 months. -What is the high guard position and what is it used for?

1. Head 2. Spinal 3. Lateral 4. Lateral 5. Towards With increased head rotation comes anatomical spine rotation (initiating from the cervical spine, then moving caudally down the spine) in the same direction the head turns. Head rotation initiates the spinal rotation and lateral weight shift of the trunk in what can be termed as a primitive or immature lateral weight shift of the trunk toward the face side. This ability to start laterally weight shift is the beginning of rolling supine to sidelying and will change significantly at approximately 5-6 months.

In the context of a 2 month old, supine position: ( 1. Head ; Spinal ) rotation initiates the ( 2. head ; spinal ) rotation and ( 3. anterior ; posterior ; medial ; lateral ) weight shift of the trunk. This ( 4. anterior ; posterior ; medial ; lateral ) weight shift of the trunk is ( 5. towards ; away from) the face side. This weight shift ability is the beginning of rolling supine to sidelying.

1. flexion and adduction 2. external rotation and abduction

In the context of prone position: As the baby is getting older, it's arms are moving from a relative position of __1__ to __2__ .

PTS Review

Months 1 - 3 Review, PTS: The neonate demonstrates some head lag. This head lag increases in the one month old due to the increase in cervical ROM. The head lag continues in the two month old. The 3 month old has head lag but will demonstrate some asymmetrical cervical flexion activation and attempt to bring the head towards the plane of the trunk. As the 3 month old nears upright, the head will come closer to the plane of the trunk and will be stabilized in midline with shoulder elevation.

Months 1 - 3 Review, Sitting

Months 1 - 3 Review, Sitting: The neonate sits with the head forward, the trunk rounded and the spine in a C-curve. The one month old sits with the spine in a C-curve and demonstrates fleeting attempts to lift the head up. The two month old will be able to keep the head up better but the back will still be rounded. The two month old will also begin to use the high guard position of the arms to assist with trunk extension. The 3 month old has increased cervical extension and is capable of keeping the head upright for long periods of time. The 3 month old also has more extension through the thoracic region and will use high guard to increase thoracic extension.

Months 1 - 3 Review, Unsupported Sitting

Months 1 - 3 Review, Unsupported Sitting: When external support is removed, the infant will collapse forward. The 1 month old will be unable to lift the head from the support surface. The 2 month old will be able to use the hands and the cervical extensors to lift the head off the support surface. The 3 month old will be able to lift the head farther off the support surface with increased use of the cervical extensors.

Lift the head off the support surface and rotate it slightly while in extension; let's baby visually explore environment.

The infant's primary movement at 2 months of age is to _____ .

4 months

These are developmental milestones for which month? -Hands usually open -PTS: no head lag

Newborn

These are developmental milestones for which month? -Physiological flexion -Hands fisted -Supine: head to side -Complete head lag

2 months/ Asymmetrical Period

These are developmental milestones for which month? -Physiological flexion resolved -Supine: head rarely in midline -Standing: abasia, astasia

6 months

These are developmental milestones for which month? -Sitting: ring sits independently -Rolling: prone to supine and supine to prone

3 months/ Symmetrical Period

These are developmental milestones for which month? -Supine: head in midline -prone on elbows with head and trunk up without bobbing -abasia/astasia gone

9 months

These are developmental milestones for which month? -transitions into and out of sitting -sits independently x10 minutes -Creeps on hands and knees -Can go from sitting to quadruped to sitting

11 months

These are developmental milestones for which month? Cruises Walks with 1-2 hands held Stands independently

8 months

This is a developmental milestone for which month? -Commando crawls on belly

12 months

This is a developmental milestone for which month? Takes 5 steps independently

5 months

This is a developmental milestone for which month? Weight shifts in prone on extended arms

Extensor

Which term correctly completes the sentence: An ATNR is usually observed more frequently in babies with more ( flexor ; extensor ) tone.

The 1 month old will demonstrate greater head lag on pull to sit than the neonate did because the 1 month old has begun to elongate the cervical flexors which gives the infant increased range of motion into cervical extension. It is important to realize that the increased head lag on PTS is due to increased cervical ROM and not due to decreased head control. The infant still does not make any attempt to help pull itself into sitting.

With 'pull to sit' who has a greater head lag, a neonate or a 1 month old? Why?

-Less of a head lag -Indicates baby is beginning to activate the cervical flexors -There will be some activation of the infant's arms as though the infant is trying to help pull itself into sitting

With pull to sit in a 2 month old: is there more, less, or an equivalent amount of head lag as compared to 1 month? What does this indicate? Is the baby able to help pull up through their arms during this motion?

the trunk extensors.

You see an older infant assume the high guard position in sitting indicating of weakness in _____ .