Motor (and Sensory) Development

Why is it important?

This is my new favorite article: https://www.ewi-ssl.pitt.edu/psychology/ad

min/faculty-publications/201008311333100.Iverson_2010.pdf

http://www.people.com/people/archive/article/0,,20353593,00.html

http://www.autismspeaks.org/science/science_news/kennedy_krieger_early_signs.php

https://www.ewi-ssl.pitt.edu/psychology/admin/faculty-publications/201008311333100.Iverson_2010.pdf







“Development results from interrelated processes of maturation, physical growth, and learning and may be observed in genetic and environmental adaptation”- Cech & Martin (2002), p. 51.◦ Maturation= genetics/biophysical◦ Adaptation= body’s response to the environment

◦The progression from reflex dominance to increasingly

advanced motor skills

1) Sequential: across cultures, despite individual differences

2) Directional concepts:a) Cephalocaudalb) Proximaldistal

3) Mobility & Stability: the relationship between these is=postural control

4) Sensory Input: first movements or reflexes are initiated by sensation and continues with voluntary control.

Vision Somatosensory:

◦ Tactile:◦ Proprioception: interpreting stimuli originating

in muscles, joints and other internal tissues that give info. about position of body part in relation to another

Vestibular: interpreting stimuli from the inner ear receptors regarding head position and movement

04/22/23Motor Development 5

Reflexes• Predictive movements in response to a

stimuli• The integration of reflexive reactions

follows a sequence that correlates with the acquisition of motor skills

•Present in the neonatal and become integrated in time; persistence beyond the time of anticipated decline may signal brain

abnormalities•Almost all reflexes should be integrated

by 9-12 months


Asymmetric Tonic Neck Reflex

http://www.babyzone.com/baby/nurturing/photos_physical_development_milestones/3

http://www.babyzone.com/baby/nurturing/photos_physical_development_milestones/3

Righting Protective Equilibrium See Table 9-2

Nature versus Nurture

Automatic responses to sensory input that act to keep the body parts in alignment, maintain equilibrium and prevent injury.

Are of primary importance with static and dynamic balance.

Appear between 2-18 months, with few exceptions, persist throughout life.

3 categories: righting, protective, and equilibrium


Automatic postural responses elicited by sensory input that signal that the head or trunk is not in midline.

Think of examples…


To prevent or break a fall. Elicited by vestibular input that signals a

change in head position. These reactions are often delayed or absent

in persons with severe disabilities. How would this impact occupational

performance???



Protective Reaction

To prevent falls Elicited by vestibular input from any

position. Appear between 5-18 months of age and

persist for life. 5 key positions for testing:

◦ Prone, supine, sitting, all fours, and standing (tilt board)



Equilibrium Reaction


• Variations exists in all areas of development

• ”Abnormal motor development cannot be recognized and

correctly interpreted without a solid knowledge of normal motor

development” (Piper & Darrah, 1994, p.2)

• Use normal motor development as a reference point to

understand abnormal motor development and establish

treatment techniques

Motor development


Conditions: CP TBI Genetic Syndromes ….What are these related to? NEUROLOGICAL INTEGRITY

http://aut.sagepub.com/content/early/2011/05/19/1362361311402230.abstract


Inconsistency Perseveration Mirroring Asymmetry Loss of dynamic balance Falling after performance Extraneous movements Inability to maintain rhythm or pattern Inability to control force Inappropriate motor planning


Primitive reflexes do NOT appear in the first year of life.

Primitive reflexes appear, but do NOT DISAPPEAR by the end of the first year.

Equilibrium reactions do not appear by the end of the first year.

Equilibrium reactions do not persist throughout life.

http://pathways.org/awareness/healthcare-professionals/early-motor-surveillance/




The degree of normal tension in a specific muscle or muscle group

The resistance of passive stretch Constant state of reflex contraction For body posture


Hypotonus◦ Too little tension◦ Characterized by unusual postures and increased

joint ROM Hypertonus

◦ Increase muscle tone◦ Too stiff to perform movements properly◦ Spasticity and rigidity significantly limit ROM

Athetosis◦ Exhibit both hyper and hypo tonus

1 Statistics compiled by the Pathways Awareness Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and Prevention

Celebrating over 25 years of assuring the best for all babies’ development

Recognizing Early Motor Delays At Four and Six Months of Age

“Early motor delays” is used to describe a variety of conditions from low muscle tone to cerebral palsy.

Early motor delays can later affect a child’s ability to learn basic skills such as grasping, crawling, standing, walking, and talking.

Early Motor Delays

Early Motor DelaysTummy TimeSurveillance

Recognizing Early Motor Delays

4-month comparison 6-month comparison

ReferralsEarly Intervention

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Tummy Time

Supervised time while awake that babies spend on

their stomachs





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Tummy Time is critical for building muscle strength in the core, back, neck, and

shoulders; strength children need to meet their

developmental milestones.

“a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. The components of developmental surveillance include eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.”2





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Dworkin defined developmental surveillance:

Observe in more than one positionObserve the quality of the movement


At the 2, 4 and 6 month Well Visit

1. Supine2. Sidelying3. Prone4. Pull to Sit5. Sitting6. Horizontal

Suspension7. Protective Response8. Standing

Atypical

Good vertical alignment from head to feet

No independent head lifting

Typical Eight positions to observe movement





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Click on image to play video Handout #9





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Click on image to play video Handout #10

http://pathways.org/awareness/parents/developmental-milestones/atypical-and-

typical-infant-development#.UUNpRxc3txV

http://www.pathways.org/?utm_source=bracelet&utm_medium=ppt&utm_campaign=4_6_month_motor

http://pathways.org/images/random_pdfs/Hot-Topics-2-months.pdf



2 month old

4 month old

6 month old






Referrals If you assess a child and observe a

potential early motor delayEarly Motor DelaysTummy TimeSurveillance




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Next step: Refer your patient for an evaluation or

a screening by a specialist

Handout #11

Pediatric Occupational Therapy

Early Intervention… What is it?

Pediatric

PhysicalTherapy

PediatricSpeech/Language

Therapy

Pediatric therapy provided early improves the abilities of a child





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Thank you for taking the time to learn about Pathways.org and recognizing early

motor delays. We hope that this overview of four and six month motor development has

provided you with the skills and tools to:

•Understand the importance of surveillance •Identify early motor delays at the 4 and 6 month

visits using structured observation•Refer children for further screening as soon as

possible





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American Occupational Therapy Association (AOTA): www.AOTA.org

American Physical Therapy Association (APTA): www.APTA.org

Neuro-Development Treatment Association (NDTA): www.NDTA.org

State-by-State Early Intervention:

www.pathways.org/awareness/parents/parent-resources/your-states-child-early-

intervention-offices

Pediatric Neurologist: www.childneurologysociety.org

Developmental and Behavioral Pediatricians:

www.sdbp.org/find_a_clinician.cfm

Easter Seals: www.easterseals.com

Pathways: www.pathways.org





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Handout #12

Recommended Organizations

Sensory Processing Disorder

Sensory Modulation Disorder (SMD)

Sensory Over- Responsivity

Sensory Under-

Responsivity

Sensory Seeking/ Craving

Sensory Based Motor Disorder (SBMD)

Dyspraxia Postural Disorders

Auditory

TactileTaste/Smell

Visual

Sensory Discrimination Disorder (SDD)

Position/Movement

(Miller, Anzalone, Lane, Cermak, Osten, 2007)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109213/

http://www.aota.org/Educate/Research/CATsandCAPs/SI.aspx

Q & A

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Motor (and Sensory) Development