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

2 Organization Functional Activities (Behaviors) Control of posture and movement Status of individual systems

3 Seven – Nine Months

4 F unctional 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

5 Baby Pictures

6 F unctional 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)

7 Baby Pictures

8 F unctional 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

9 Baby Pictures

10 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 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)

11 Baby Pictures

12 Posture and Movement: 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

13 Baby Pictures

14 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

15 Baby Pictures

16 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

17 Baby Pictures

18 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

19 Baby Pictures

20 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

21 Baby Pictures

22 Review of Systems Neuromuscular Muscular Sensory Resiratory Cardiovascular

23 Movie of Babies

24 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

25 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

26 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

27 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

28 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

29 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

30 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

31 Cardiovascular: 7-9 M Cardiovascular – bpm…..average is 120

32 Any Questions for me?

33 Ten – Twelve Months

34 F unctional 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

35 Baby Pictures

36 Posture and Movement: 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

37 Baby Pictures

38 Posture and Movement: 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)

39 Baby Pictures

40 Posture and Movement: 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

41 Baby Pictures

42 Posture and Movement: M Dissociated control of reaching, grasping and releasing –Grasps: radial digital, inferior pincer, pincer, thumb opposition –Isolated finger use

43 Baby Pictures

44 Review of Systems Neuromuscular Muscular Sensory Respiratory Cardiovascular

45 Movie of Babies

46 Neuromotor System: 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

47 Musculoskeletal: M Good strength in LE’s Full range everywhere, but with growth spurts, needs to regain range and strength

48 Sensory: 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

49 Respiratory/ Cariovascular: 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 – bpm….average is 120

50 Any questions? Catch you on the flip side…

51 Thanks to: Joyce Checksfield, PT, MA Loren J. Arnaboldi, MA, CCC-SLP for the original template for this presentation 2004 Jane Styer-Acevedo & Margo Prim Haynes 2005 Jan McElroy, Jane Styer-Acevedo, Loren Arnaboldi for their picture contributions