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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)
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
- 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
- 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
- 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
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
Normal 24 mo
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
6 mo
6-8 mo
Milestone Pokes forefinger; pincer grasp; finger feeds; hold bottle Throws objects, voluntary release; mature pincer grasp
Normal 9 mo
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
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)
Overprotectiveness Firstborns tend to be ahead of later borns in motor development Prematurity level of development at birth is below
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
Primitive Reflexes
Moro
Asymmetric Tonic Neck Reaction Neck Righting Reaction Stepping reaction Placing reaction Plantar grasp Palmar grasp Gallants reaction
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
- 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.
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
- 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
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)
- 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)