Lecture 12 Motor Development

8/12/2019 Lecture 12 Motor Development

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IGA TRISNA WINDIANI


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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


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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)


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Head control: prone, ventralsuspension, pull to sittingProne

- 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 mo1 mo2 mo

3-4 mo3-5 mo5-6 mo

Motor developmental milestone


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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

newborn

6 wk2 mo3 mo

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

3 mo

5 mo6 mo

7 mo


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- Voluntary release of objects

- Plays pat-a-cake- Enjoys putting objects in and out of box- Casting objects

Tower of 2 cubesTower of 4 cubesTower of 6-7 cubesTower of 10 cubes

Good use of cup and spoon

10 mo

9-10 mo 11 mo

10-13 mo13-15 mo

18 mo2 y3 y

15-18 mo


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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 stepdown, two feet per step up

- Up and down stairs, one foot per step- Jumps off ground with two feet

3 mo6 mo9 mo

11 mo12 mo13 mo15 mo

2 y2 y

3y

4 y2.5 y


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- Hops on one foot

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

4 y

5-6 y3 y4 y


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Motor Developmental Red Flags

Milestone Normal Concern if not

acquired byGROSS MOTOR

Head up/chest off inprone position

2 mo 3 mo

Rolls front to back,back to front

4-5 mo 6-8 mo

Sits well unsupported 6 mo 8-10 mo

Creeps, crawls, cruises 9 mo 12 moWalks alone 12 mo 15-18 mo

Runs; throws toy, fromstanding without fall

18 mo 21-14 mo


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Milestone Normal Concern if notacquired by

Walks up and downsteps

24 mo 2-3 years

Alternates feet onstairs; pedals trike

3 years 3 - 4 years

Hops, skips; alternatesfeet going down stairs

4 years 5 years

FINE MOTOR

Unfists hands, touches

object in from of them

3 mo 4 mo

Moves arms in unisonto grasp

4-5 mo 6 mo

Reaches either hand,

transfers

6 mo 6-8 mo


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Milestone Normal Concern if notacquired by

Pokes forefinger;pincer grasp; fingerfeeds; hold bottle

9 mo 1 year

Throws objects,voluntary release;

mature pincer grasp

12 mo 15 mo

Scribbles in imitation;holds utensil

15 mo 18 mo

Feeds self with spoon;

stacks 3 cubes

18 mo 21-24 mo

Turns pages in books;is ready cup drinker;removes shoes and

socks

24 mo 30 mo


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Milestone Normal Concern if notacquired byUnbuttons; has adultpencil grasp

30 mo 3 years

Draws a circle 36 mo 4 years

Buttons clothes;catches a ball

4 years 5 years


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Some conditions that influence the rate ofmotor 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


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..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 belowthat of full-term infants

Physical defects (e.g. blindness)

Good health & nutrition Sex, racial, and socioeconomic differences in

motivation & child-training methods


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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


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Primitive reflexes are assumed to represent thedominance of lower levels of the CNS (the subcorticalnuclei located in the brain stem)

The integration of these early reflexes is perceived to

indicate maturation of the CNS and inhibition of thelower centers by the higher functioning cerebralcortex

Presence or lack of primitive reflexes are usedextensively in infant motor assessments to evaluatethe level of neurological integrity


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Primitive Reflexes

Moro Asymmetric Tonic Neck Reaction Neck Righting Reaction Stepping reaction Placing reaction Plantar grasp

Palmar grasp Gallants reaction


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Primitive and postural reflexes

Present by Absent byMoro birth 5-6 moPalmar grasp birth 6 moPlantar grasp birth 9-10 mo

Rooting birth 3 mo

Asymmetricaltonic neck

birth 5-6 mo

Placing/stepping birth 1.5-2 mo

Parachute 8-9 mo persist

Landau 10 mo 1 y


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Moro Reaction

- For this examination, lay thechild upon one forearm andsupport its head with otherhand. Then the hand holdingthe childs head is lowered.

- The childs head falls intothe opened hand. The childopens its mouth, the armsare lifted and opened, thefingers are stretched apartlike a fan (1 st phase). Thenthe mouth is closed again,the arms are bent and joinedtogether again in front ofthe childs body (2 nd phase).


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ATNR(Asymmetric Tonic Neck Reaction)

- If the childs head isturned to one side, theextremities of thefacial side arestretched, and theextremities of theoccipital side arebent.

- This is the so-calledfencers position.


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Asymmetric Tonic Neck Reaction

- In the most cases this reaction produces only oneeffect on the extremities, which can be demonstratedelectromyographically.

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


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Neck Righting Reaction

- The examiner turns thelying childs head toone side.

- The childs entire bodyfollows the turn; thechild turns en bloc.

- Should this reactionpersist, rotationbetween head and bodyand, with this, sitting upfrom a supine positionwith the help of turning,

becomes impossible


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- The child is held up vertically by the trunkwith both hands- If the sole of one foot is pressed onto the

underlying surface, the corresponding legwill bend upon contact and the other will

stretch- The stretched foot then touches the surface,

the leg bends, and the previously bent legthen stretches

- This alternating movement gives the

impression of stepping (marcheautomatique). The upper part of thechilds body is tilted slightly forward

Stepping reaction


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- The child is held under the arms with

its feet under the edge of a table. Thechild is slowly lifted in such a waythat the instep of its foot slightlytouches the bottom edge of the table,and, as a result, the foot climbsover the tables edge

- This reaction is also called theclimbing reaction, since the childgives the impression of being able toclimb over the edge of the table

Placing reaction


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Plantar Grasp Reaction

- Contact with the balls of thefeet causes the toes to clutchtogether. When the contact isremoved, the toes spreadapart.

- Should this reaction persist,standing on flat feet andwalking (including the rollingmovement) are not possible


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Palmar Grasp Reaction

- Contact with the palm of the handstimulates the hand to close. Aslong as this stimulus remains, thehand may remain closed.

- It is possible to pull the childupward by the hands in thisposition. The elbow joints remainslightly bent.

- Should this reaction persist for asubstantial amount of time, thechild will not be able to supportitself on its open palms ( nobalance reactions). This becomesphysiologically strengthenedthrough sucking


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Gallants reaction

- If the child is strokedparavertebrally with one finger,its body curves. The concavityproceeds toward the

direction of the stimulus; thepelvis is raised.

- The corresponding leg and armare stretched, the oppositeextremities are curved.

- This reaction is often alsocalled the spinal reaction


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Rooting Reflex

- If the child is hungry, itmoves its head withoutexternal stimuli. If acorner of the childsmouth is touched by afinger or any other item(e.g. a bottle), thechilds head turns in

the direction of thestimulus (rootingreaction, reflexe despoints cardinaux)


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Parachute Reaction

- The examiner hold the infant withboth hands around the waist at thetrunk and lowers its head relativelyfast to the surface below.

- Before the head reaches the surfacethe arms are extended (opticalreadiness to jump), and later thetransfer of body weight to the armsoccurs. Just as readiness to standbelongs to the reactions of balance,so does this parachute reaction andremains for life. Typical fractures ofthe radius are the results of thisreaction


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Landau Reaction

- If the child is suspendedhorizontally- with the examinershands wrapped round its trunk-the child will automatically lift itshead and the legs follow thismovement by extending(craniocaudal).

- Should the head suddenly bend,the childs entire the body bends.

- This reaction is necessary for afew months during the first yearof life in order for the child toexperience the feeling of its bodyin given areas (bodyschema)


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Labyrinthine Righting Reaction

- When the child is laid on itsabdomen or its position ischanged within a given space,the childs head adjusts itself

to the surroundings; the childraises its head. This reactioncan also be triggered in a head-down position.

- In some children with cerebraldisturbances of movement thisis missing and results in lackof head control


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Lecture 12 Motor Development

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