1 Aspects of Typical Development Margo Prim Haynes, PT, DPT, MS, PCS Gail Ritchie, OTR/L Mary Rose Franjoine, PT, DPT, MS, PCS Jan McElroy, PT, MS, PCS.

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Aspects of Typical Development

Margo Prim Haynes, PT, DPT, MS, PCSGail Ritchie, OTR/L

Mary Rose Franjoine, PT, DPT, MS, PCSJan McElroy, PT, MS, PCS

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Organization

• Functional Activities (Behaviors)

• Control of posture and movement

• Status of individual systems

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Seven – Nine Months

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Functional Behaviors: 7-9 M• Moving in environment…..

– Rolling (6 months)– Moving on belly, commando crawling & creeping– Creeping with variety (9 months)

• Sitting options increases…..– LE variety* – Rotation in sitting and vaulting (8-9 months)– Recovers balance in sitting (9 month)

• Transition in and out of sitting

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Baby Pictures

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Functional Behaviors: 7-9 M

• Pull to stand (8 months) – Pull with UE– Immature half-kneel & squat

• Standing with BOS decreasing • Cruising & creeping upstairs with immature WS• Walking with two hands held (9 months)

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Baby Pictures

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Functional Behaviors: 7-9 M

• Changing grasp patterns emerges– 9 months: repertoire of grasps to accommodate

size and shape of objects• Finger feeding…cup drinking• Producing variety speech sounds

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Baby Pictures

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Posture and Movement: 7- 9 M• Fully competent in prone, Pivots to both sides

– Pushing into backward space (7 months) – Forward progression with homolateral creeping (7-8

months)– Counter rotation (creeping) begins end of 9 month with

refinement 10-11 months • Uses phasic burst initially to get up into quadruped (7-8

months)– Rocks on all fours & as strength improves can un-weight

the support limbs for forward progression (8-9 months)

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Baby Pictures

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Posture and Movement: 7 - 9 M• Uses rotation for transitions

– Leads with both UE’s and LE’s• Rather not be in supine (7 months)

– Active extension through hips …..bridging– Has full control of UE and LE vaulting

• Prefers play in side-lying – Has control for UE Vaulting– Graded control of elbow extension in weight bearing arm

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Baby Pictures

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Posture and Movement: 7-9 M• Sustained control around pelvis allows variety of

sitting positions and freedom of UE’s for play– Long, short & tailor– “W” sit and side site emerge with active internal rotation (9

months) – Can hold a toy, while reaching out to obtain another

• Control of rotation in sitting• Dissociation of LE’s

– Vaulting over LE’s to get to all fours

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Baby Pictures

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Posture and Movement: 7-9 M

• Dissociated control of reaching, grasping and releasing

• Oral Motor– Upper lip more active for clearing spoon– Create seal to suck liquid out of cup

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Baby Pictures

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Posture and Movement: 7-9 M

• Attempt to pull up to stand with activation of the latissimus

• Uses extension to stand– Active gluts– Wide BOS

• Attempts rotation in supported standing with pelvis locked

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Baby Pictures

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Posture and Movement: 7-9 Months• Cruises along support surfaces with abdominal support

and immature lateral flexion• First attempt to walk move with immature weight shift

– Caregiver walks baby

• Walks with two hands held– First attempt to walk with immature weight shift with

help of caregive– Trunk rotation yields longer stride

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Baby Pictures

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Review of Systems

• Neuromuscular • Muscular• Sensory• Resiratory• Cardiovascular

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Movie of Babies

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Neuromotor System: 7-8 M• ↑ grading of co-activation for proximal stability and

distal mobility• Rocking improves control of mid-ranges in UE’s and

LE’s• Developing synergies between abdominals and hip

flexors• Rotation is observed in commando crawling, but not

in transitions to alternate positions• ↑ activation of quadriceps, but only in concentric

contractions

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Neuromotor System: 8-9 M

• LE’s used for weight bearing• Shifts between holding with hip flexors/low back

extensors and hip extensors/abdominals– Key synergies for sit/stand transition

• Emerging plantar flexion in kneeling/quadruped• Improved eccentric control in LE’s, but not enough

to control transition down from standing

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Musculoskeletal: 7-8 M• Elongates hamstrings & tensor fascia lata• Increased wrist range in quadruped• Further elongation of thenar eminence to separate

thumb from hand• Continues to elongate long finger flexors• Commando crawl strengthens UE’s into “good”

range

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Musculoskeletal: 8-9 M

• Increased hip mobility for internal/external rotation (possibly from playing in “W” sit)

• Dorsiflexors elongated in pull-to-stand• Plantarflexors elongated in bear standing• Weight shifts in all fours helps to develop arches of

hand• Increased hip abductor strength• Ankle remains weakest part of LE

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Sensory: 7-8 Months• Proprioceptive/tactile

– Self generated deep pressure to hands and knees in all fours– Experience varied surfaces

• Linear Vestibular input in rocking & bouncing• Vision

– Improved depth perception & discrimination of objects at distance

• Auditory– Discrimination of speech sounds and able to start matching it

in imitation

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Sensory: 8-9 M• Proprioception / kinesthesia (9 -10 months)

– Improved proprioception in LE’s– Increased awareness of relationship between

pelvis/femur and heel/toe patterns• Vestibular

– Increased with greater acceleration• Interplay of cognitive ability with perception in the

development of object permanence

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Respiratory: 7-9 M

• Ribs are angled down with greater space in between

• Can vocalize without moving• Eccentric control of intercostals allows for longer

voice production and reduplicated babbling• Adult inflections can be heard

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Cardiovascular: 7-9 M

• Cardiovascular– 80-160 bpm…..average is 120

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Any Questions for me?

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Ten – Twelve Months

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Functional Behavior: Ten to Twelve Months

• Competent in sitting, transitioning in and out of sit, and creeping

• Emerging independent standing and stepping• Cruises well and walks with one hand on furniture• Climbing • Refined grasps and repositions object in hand• Releases food into mouth• Jargon speech with possible words mixed in

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Baby Pictures

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Posture and Movement: 10-12 M

• Getting in and out of sitting progresses to vaulting with mature weight shift– Vaulting results in control of hip abductors &

adductors and thus a decreased BOS & emerging trunk rotation in standing

• Varied sitting postures continue: long, short, tailor, & “W”

• True counter rotation in creeping

– Less trunk movement and more control of flexion and extension of the hips and knees

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Baby Pictures

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Posture and Movement: 10-12 M• Improved hip control allows for bench sitting, tall

kneeling and standing with pelvis free• Stands up through half-kneel, but continues to

need both legs to push up from squat• Rotates over support leg with lateral weight shift

(begin 10 m)

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Baby Pictures

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Posture and Movement: 10-12 M• Eccentric control available for the first half of

downward transitions• Independent standing biased towards extension• Mature weight shifts noted for half-kneel,

standing and cruising• Immature weight shifts for independent stepping

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Baby Pictures

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Posture and Movement: 10-12 M

• Dissociated control of reaching, grasping and releasing – Grasps: radial digital, inferior pincer, pincer,

thumb opposition– Isolated finger use

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Baby Pictures

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Review of Systems

• Neuromuscular • Muscular• Sensory• Respiratory• Cardiovascular

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Movie of Babies

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Neuromotor System: 10-12 M

• Continue to improve graded control of co-activation in LE’s

• Graded control of stiffness to allow stability in antigravity positions without external support

• Varied repertoire of complex coordinated movements

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Musculoskeletal: 10-12 M

• Good strength in LE’s• Full range everywhere, but with growth spurts,

needs to regain range and strength

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Sensory: 10 - 12 M

• Perception has shifted… “I am a walker”• Increased proprioception due to weight bearing on

all aspect of the feet• Enjoys vestibular input from swinging• Explores more of environment than body• May perseverate on tasks and have difficulty

terminating activity• Decreased reliance on vision for reaching and

seating self

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Respiratory/ Cariovascular: 10-12 M• Respiration

– 30-50 beats per minute– Can elongate respiration for spund play – Long volume continues to increase during this time with

expansion of alveoli– Allows for continued increase of vocalizations

• Caridovascular– 80-160 bpm….average is 120

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Any questions?Catch you on the flip side…

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Thanks to:Joyce Checksfield, PT, MA

Loren J. Arnaboldi, MA, CCC-SLP for the original template for this presentation

2004Jane Styer-Acevedo & Margo Prim Haynes

2005 Jan McElroy, Jane Styer-Acevedo, Loren Arnaboldi for

their picture contributions 2001-2009