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IGA TRISNA WINDIANI

Principles of Motor Development


Movement progresses from primitive, mass movement reflex patterns to voluntary, controlled movement Motor development depends on neural and muscular maturation Motor development follows a predictable pattern (cephalocaudal; proximodistal) There are individual differences in the rate of motor

development

Motor Development

Gross motor skill Physical skill that involves the large muscles (like jumping or running) Fine motor skill Ability that involves the small muscles (like buttoning or copying figures)

Motor developmental milestone


Head control: prone, ventral suspension, pull to sitting Prone - Head rests on table turn to one side - Lifts head momentarily - Head up 45 degrees - Head up 90 degrees - Weight on forearms - Weight on hands with arms extended

1 mo 1 mo 2 mo 3-4 mo 3-5 mo 5-6 mo

Ventral suspension - Head hangs completely down - Momentarily holds head in plane of body - Head sustained in plane of body - Maintains head beyond plane of body Pull to sitting - Complete head lag, back uniformly rounded - Slight head lag - No head lag, back straightening - Lifts head off table when about to be pulled up - Raises head spontaneously from supine

newborn 6 wk 2 mo 3 mo Newborn 3 mo 5 mo 6 mo 7 mo

Rolling - Rolls front-to-back - Rolls back-to-front Sitting - Back uniformly rounded, cannot sit unsupported - Back straightening, sits with propping - Back straight, sits with arms forward for support - Sit with no support

4-5 mo 5-6 mo newborn 5-6 mo 6-7 mo 7 mo

Fine motor / manipulation

- Hand predominantly closed - Hand predominantly open - Hand regard - Hand come together - Foot play - Voluntary grasp (no release) - Transfers objects from hand to hand - Ulnar grasp of cube - Grasps cube against thenar eminence - Grasps cube against lower thumb - Mature cube grasp-finger tips and distal thumb - Index finger approach to small objects and finger-thumb opposition

1 mo 3 mo 3-5 mo 4 mo 5 mo 5 mo 6 mo 5-6 mo 6-8 mo 8-10 mo 10-12 mo


10 mo

- Voluntary release of objects - Plays pat-a-cake - Enjoys putting objects in and out of box - Casting objects Tower of 2 cubes Tower of 4 cubes Tower of 6-7 cubes Tower of 10 cubes Good use of cup and spoon

10 mo 9-10 mo 11 mo 10-13 mo 13-15 mo 18 mo 2y 3y 15-18 mo

Weight-bearing and walking

- Some weight bearing - Supports most weight - Pulls to stand - Walks holding onto furniture (cruising) - Walk with one hand held - Walk without help - Walk well - Runs well - Up and down stairs, two feet each step - Up and down stairs, one foot per step down, two feet per step up - Up and down stairs, one foot per step - Jumps off ground with two feet

3 mo 6 mo 9 mo 11 mo 12 mo 13 mo 15 mo 2y 2y 3y
4y 2.5 y

- Hops on one foot - Skips - Balance on one foot 2-3 s - Balance on one foot 6-10 s

4y 5-6 y 3y 4y

Motor Developmental Red Flags


Milestone GROSS MOTOR Head up/chest off in prone position 2 mo 3 mo Normal Concern if not acquired by

Rolls front to back, back to front Sits well unsupported


Creeps, crawls, cruises

4-5 mo
6 mo 9 mo

6-8 mo
8-10 mo 12 mo

Walks alone
Runs; throws toy, from standing without fall

12 mo
18 mo

15-18 mo
21-14 mo

Milestone Walks up and down steps

Normal 24 mo

Concern if not acquired by 2-3 years

Alternates feet on stairs; pedals trike Hops, skips; alternates feet going down stairs FINE MOTOR
Unfists hands, touches object in from of them Moves arms in unison to grasp

3 years
4 years

3 - 4 years
5 years

3 mo 4-5 mo

4 mo 6 mo

Reaches either hand, transfers

6 mo

6-8 mo

Milestone Pokes forefinger; pincer grasp; finger feeds; hold bottle Throws objects, voluntary release; mature pincer grasp

Normal 9 mo

Concern if not acquired by 1 year

12 mo

15 mo

Scribbles in imitation; holds utensil Feeds self with spoon; stacks 3 cubes Turns pages in books; is ready cup drinker; removes shoes and socks

15 mo
18 mo 24 mo

18 mo
21-24 mo 30 mo

Milestone Unbuttons; has adult pencil grasp Draws a circle Buttons clothes; catches a ball

Normal 30 mo 36 mo 4 years

Concern if not acquired by 3 years 4 years 5 years

Some conditions that influence the rate of


motor development
Genetic constitution, including body build &

intelligence
The more active the fetus the more rapid is motor development in early postnatal life Favorable prenatal conditions (e.g. maternal nutrition) A difficult birth ( e.g. brain damage)

Good health & nutrition


High IQs more rapid motor development Stimulation, encouragement, and opportunity

..Some conditions that influence the rate of motor development

Overprotectiveness Firstborns tend to be ahead of later borns in motor development Prematurity level of development at birth is below

that of full-term infants


Physical defects (e.g. blindness) Good health & nutrition

Sex, racial, and socioeconomic differences in


motivation & child-training methods

GROSS MOTOR DEVELOPMENT


Primitive reflex Postural reflexes - Righting reflex - Optical righting reaction - Labyrinthine righting reaction on the head - Body righting reaction on the head - Body righting reaction on the body - Protective reflex - Parachute reaction - Propping protective reaction - Equilibrium reflex

Primitive reflexes are assumed to represent the dominance of lower levels of the CNS (the subcortical nuclei located in the brain stem) The integration of these early reflexes is perceived to indicate maturation of the CNS and inhibition of the

lower centers by the higher functioning cerebral cortex


Presence or lack of primitive reflexes are used extensively in infant motor assessments to evaluate the level of neurological integrity

Primitive Reflexes
Moro

Asymmetric Tonic Neck Reaction Neck Righting Reaction Stepping reaction Placing reaction Plantar grasp Palmar grasp Gallants reaction

Primitive and postural reflexes


Moro Present by birth Absent by 5-6 mo

Palmar grasp
Plantar grasp Rooting Asymmetrical tonic neck Placing/stepping Parachute

birth
birth birth birth birth 8-9 mo

6 mo
9-10 mo 3 mo 5-6 mo 1.5-2 mo persist

Landau

10 mo

1y

Moro Reaction
For this examination, lay the child upon one forearm and support its head with other hand. Then the hand holding the childs head is lowered. The childs head falls into the opened hand. The child opens its mouth, the arms are lifted and opened, the fingers are stretched apart like a fan (1st phase). Then the mouth is closed again, the arms are bent and joined together again in front of the childs body (2nd phase).

..Moro Reaction
- Should this condition persist, the child will not be able to learn to sit or to close its mouth in order to eat or speak. Saliva is not swallowed, so the child slobbers. While the childs head is in the mid-line at the starting point of this test, an asymmetry may be an indication of paresis on one side. One must be certain that the child is not lying in the ATNR position. It is important here to wait before triggering this reaction.

- The Moro reaction is always seen spontaneously when the child suddenly loses its balance. This can also be observed occasionally in adults

ATNR (Asymmetric Tonic Neck Reaction)


- If the childs head is turned to one side, the extremities of the facial side are stretched, and the extremities of the occipital side are bent. - This is the so-called fencers position.

Asymmetric Tonic Neck Reaction

- In the most cases this reaction produces only one effect on the extremities, which can be demonstrated electromyographically.

- If it persists, hand-eye coordination is hampered. It is found in children with cerebral disturbance of movement. Due to its tonically fixed posture, it renders all movement against gravity impossible.

Neck Righting Reaction


- The examiner turns the lying childs head to one side. - The childs entire body follows the turn; the child turns en bloc. - Should this reaction persist, rotation between head and body and, with this, sitting up from a supine position with the help of turning, becomes impossible

Stepping reaction
- The child is held up vertically by the trunk with both hands - If the sole of one foot is pressed onto the underlying surface, the corresponding leg will bend upon contact and the other will stretch - The stretched foot then touches the surface, the leg bends, and the previously bent leg then stretches - This alternating movement gives the impression of stepping (marche automatique). The upper part of the childs body is tilted slightly forward

Placing reaction

- The child is held under the arms with its feet under the edge of a table. The child is slowly lifted in such a way that the instep of its foot slightly touches the bottom edge of the table, and, as a result, the foot climbs over the tables edge - This reaction is also called the climbing reaction, since the child gives the impression of being able to climb over the edge of the table

Plantar Grasp Reaction

- Contact with the balls of the feet causes the toes to clutch together. When the contact is removed, the toes spread apart. - Should this reaction persist, standing on flat feet and walking (including the rolling movement) are not possible

Palmar Grasp Reaction


Contact with the palm of the hand stimulates the hand to close. As long as this stimulus remains, the hand may remain closed. It is possible to pull the child upward by the hands in this position. The elbow joints remain slightly bent. Should this reaction persist for a substantial amount of time, the child will not be able to support itself on its open palms ( no balance reactions). This becomes physiologically strengthened through sucking

Gallants reaction

- If the child is stroked paravertebrally with one finger, its body curves. The concavity proceeds toward the direction of the stimulus; the pelvis is raised. - The corresponding leg and arm are stretched, the opposite extremities are curved. - This reaction is often also called the spinal reaction

Rooting Reflex
- If the child is hungry, it moves its head without external stimuli. If a corner of the childs mouth is touched by a finger or any other item (e.g. a bottle), the childs head turns in the direction of the stimulus (rooting reaction, reflexe des points cardinaux)

Sucking and Swallowing Reaction

- According to Peiper, the newborn begins to suck at the very first food intake, and immediately thereafter it begins to swallow - In breastfed infants these reactions tend to persist a bit longer, until they are replaced by voluntary swallowing

Parachute Reaction
The examiner hold the infant with both hands around the waist at the trunk and lowers its head relatively fast to the surface below. Before the head reaches the surface the arms are extended (optical readiness to jump), and later the transfer of body weight to the arms occurs. Just as readiness to stand belongs to the reactions of balance, so does this parachute reaction and remains for life. Typical fractures of the radius are the results of this reaction

Landau Reaction
If the child is suspended horizontally-with the examiners hands wrapped round its trunkthe child will automatically lift its head and the legs follow this movement by extending (craniocaudal). Should the head suddenly bend, the childs entire the body bends. This reaction is necessary for a few months during the first year of life in order for the child to experience the feeling of its body in given areas (bodyschema)

Labyrinthine Righting Reaction


- When the child is laid on its abdomen or its position is changed within a given space, the childs head adjusts itself to the surroundings; the child raises its head. This reaction can also be triggered in a headdown position. - In some children with cerebral disturbances of movement this is missing and results in lack of head control