THE DEVELOPMENT OF

PERFORMANCE SKILLS
 MOTOR AND PRAXIS SKILLS, and RELATED BODY FUNCTIONS

● According to practice framework, motor skills allow a child to

move physically so that he or she can interact with tasks,
objects, contexts, and environment.
● Related body functions supporting the performance of motor
skills, or that lay the foundation for the development of motor
skills, includes some sensory functions,
neuromusculo-skeletal and other movement related functions
Reflexes
● Sensorimotor development in early infancy is largely
characterized by reflexes that dominate infant
movement and behavior
● Reflex behavior is an important survival function for
the infant and is primarily controlled by the more
primitive central nervous areas including the spinal
cord and brainstem
 PRIMITIVE REFLEX PATTERNS
REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
rooting Stroke side of the mouth Head turns toward the 28 weeks of gestation 3-7 months; longer
stimulus in nursed babies

(CONTINUED)
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
sucking Place fingers on Infant sucks 28 weeks gestation 3-7 months
lips
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES

PalmaR Grasp Pressure with Fingers flex in 30 weeks gestation 2 months

finger into palm tight grip
of hand
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES

PLACING (ARMS) TOUCH BACK OF HAND PLACES HAND ON 36 WEEKS GESTATION 2 MONTHS
ON TABLETOP TABLE WITH FLEXION
AND EXTENSION

Placing (legs) Touch dorsum of the Leg flexes then 36 weeks gestation 2 months
foot on tabletop extends to place
foot on table
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES

stepping Upright; slightly tip Rhythmic, 35 weeks gestation 3 months

forward placing alternating steps
some weight on
bottom of feet

(CONTINUED)
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
Plantar grasp Pressure with Toes flex 25 weeks of 12 months
finger on bottom gestation
of each foot
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES

ASYMMETRICAL TONIC IN SUPINE, TURN HEAD EXTENSION OF ARM AND 1 MONTH 4 MONTHS
NECK SIDE TO SIDE LEG ON FACE SIDE;
FLEXION OF LIMBS ON
SKULL SIDE

(CONTINUED)
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
SYMMETRICAL TONIC PRONE, WITH INFANT UPON FLEXION, ARMS 4 MONTHS 10 MONTHS
NECK ON YOUR LAP, FLEX FLEX, LEGS EXTEND;
NECK, OBSERVE; UPON EXTENSION,
THEN EXTEND NECK ARMS EXTEND, LEGS
FLEX
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
TONIC LABRYNTHINE OBSERVE POSTURE AND PRIMARILY A FLEXED 40 WEEKS 3 MONTHS
PRONE AND OBSERVE IN POSTURE IN PRONE, GESTATION
SUPINE EXTENDED POSTURE IN
SUPINE
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
LANDAU HOLD CHILD IN PRONE NECK, BACK, ARMS 5 MONTHS 7 - 12 MONTHS
SUSPENSION AND LEGS EXTENDED
 REFLEX STIMULUS RESPONSE AGES EMERGES AGES FADES
MORO SUPPORT INFANT IN ARMS ABDUCT AND 28 WEEKS GESTATION 4 MONTHS
SEMI-RECLINED EXTEND AND
POSITION, RELEASE EXTERNALLY ROTATE ,
SUPPORT MOMENTARILY FOLLOWED BY FLEXION
AND ADDUCTION
Automatic Reactions and Postural Control

● Automatic or postural reactions develop as the child

begins to gain postural control for functional
movement.
● The development of these reactions has been reported to
occur first in prone, then in supine, then in sitting,
then in quadruped position and finally in standing.
 THE DEVELOPMENT OF AUTOMATIC REACTIONS
REACTION STIMULUS RESPONSE AGE EMERGES

PROTECTIVE RESPONSES IN SITTING, GENTLY PUSH THE ARMS EXTENDS AND PLACES ON FRONT;6 - 7 MONTHS
CHILD OFF BALANCE, TO THE THE SUPPORTING SURFACE TO SIDE; 7 - 10 MONTHS
FRONT, TO EACH SIDE AND PREVENT FALLING BACK; 9 - 12 MONTS
BACKWARDS

HEAD RIGHTING IN SITTING OR IN VERTICAL CHILD MOVES HEAD POSITION 3 - 4 MONTHS

SUSPENSION, TILT THE CHILD IN OPPOSITE DIRECTION TO
GENTLY FROM SIDE TO SIDE MAINTAIN THE HEAD IN
AND FRONT TO BACK ALIGNMENT WITH THE BODY
REACTION STIMULUS RESPONSE AGE EMERGES
Neck on body righting In supine, rotate the Body rotates and child Segmental rolling
child’s head to one side rolls over to prone either emerges 4 - 5 months
as a unit (log roll) or
segmentally, with some
dissociation of the upper
and lower body

Body on body righting In supine, rotate the The child rotates upper body Segmental rolling
child’s hips to one side and rolls over to align the emerges 4 - 5 months
body
REACTION STIMULUS
Equilibrium reactions Can be tested with the child
facing you, in prone,
supine, quadruped, and
standing; tilt the child’s
supporting surface to one
side, then the other side
RESPONSE AGE EMERGES
When tilted to child’s left, Prone; 5 - 6 months
lateral flexion of the right Supine; 7 - 8 months
side of the trunk, head Sitting; 7 - 10 months
righting, abduction and quadruped; 9 - 12 months
extension of the right arm Standing; 12 - 20 months
and leg, and trunk
rotation to the right; when
tilted to the right, lateral
flexion of the left side of
trunk, abduction and
extension of the left arm
and leg, trunk rotation to
the left and head righting
1st Year Gross Motor Skills
-the ability to move against gravity, as
well as the stability of the body’s
girdles, are required for the
development of postural control for
movement
2-4 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Able to lift head 90° in prone position

● Weight bearing is mostly on the lower
chest and forearms when in prone
position
● The head is kept in midline in supine
position
● At around 4mos, neck flexions can be
observed when the baby is pulled into a
sitting position
2-4 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Not yet able to sit alone

● Back is rounded
● Occasional back extensor activity
● Stepping reflex elicited when supported
4-6 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Props on hands while neck and back are ● Rolls prone to supine and vice versa
extended (prone) ● Pivots in prone
● Shifting of weight from upper to lower ● Partial weight bearing supported
trunk standing
4-6 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Brings feet to mouth (supine)

● Side lying
● Sits independently for short periods
with hand support
● Moves in and out of sitting at around
6mos
6-8 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● No longer likes to be in prolonged ● Crawls forward

prone or supine positions
● Sits well independently
● Able to use both hands while sitting
● Moves in and out of sitting easily
● Full weight bearing observed in
supported standing
● Begins to take steps when held at both
hands
8-10 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Plays well in supported sitting ● Pulls self up to stand

● Easily moves in and out of sitting ● Walks with one or both hands held
10-13 Months
LYING, SITTING, QUADRUPED STANDING & LOCOMOTION

● Child may bear walk ● May walk well with on hand held
● Cruises around furniture
EVALUATION
● Assessment tools include but are not limited to: Motor Assessment of
Infants, Clinical Observations of Motor Performance: 2nd Edition, and
The Toddler and Infant Motor Performance.
● Formal and Informal clinical observations are used to examine reflexes
and autonomic reaction, as well as quality of movement.
● Be familiar with necessary stimuli and positions when trying to elicit a
response.
● In order for a child’s fine and gross motor skills to be developed, there
must be a foundation in normal autonomic reactions, integration of
primitive reflexes, and development of postural control.
 GROSS MOTOR SKILLS
● The body’s gross motor skills’ development and performance depends upon
these functions:
○ Muscle Strength ○ Cognitive Components

○ Postural Control and Balance ○ Psychological Components

○ Muscle Tone ○ Contextual Factors

○ ROM and Agility ○ Motor Planning

○ Motor Coordination ○ Sensory Awareness &

Processing
GROSS MOTOR SKILLS
● The same functions needed for the development of gross motor skills are also
needed for the development of fine motor skills such as pinching and reaching
● Generally, upper extremity function progresses from gross motor to fine motor
movements and proximal to distal
● Hand function develops from ulnar side to radial side
● Oral-motor skills are defined as fine motor skills. Speech pathologists and
Occupational Therapists both evaluate a child’s oral-motor skills
Development of Gross
Motor Skills From 1-18
Years of Age
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 1 – 1.5 years
Functional Mobility Gross Motor Skills

● Walks well for very ● Crawls up and down

short distances stairs with
● May use wide base of supervision
support, and falls ● Rides a push riding
frequently, especially toy
over uneven ground ● Throws toys with
● Uses high chair for little accuracy
meals ● Climbs up a ladder
● Crib for sleeping for with supervision
long walks
 Functional Mobility Gross Motor Skills
1.5 – 2 years ● Begins to run, ● Jumps clearing both feet from
although poorly the ground
coordinated ● Walks up and down stairs by
● Jumps down from a placing both feet on each step
raised surface for a and using railing for support
few inches with one ● Kicks and tosses a ball but with
foot leading little accuracy
● Walks short distances ● Uses a playground slide with
● Typically uses minimal assistance and enjoys
stroller for longer playing on playground
walks equipment designed for
● Continues to use high toddlers
chair for meals and ● Likes to walk with pull toys; and
crib for sleeping operates push riding toys
easily.
2 - 3 years Functional Mobility Gross Motor Skills
● Begins to negotiate ● Rides a tricycle
playground equipment ● Enjoys playground
but needs close equipment,
supervision running,jumping and
● Needs assistance to use climbing
standard-sized toilets ● Jumps down from a
● Continues to require a raised surface with both
stroller for longer walks feet together
● Running is better ● Catches a medium-sized
coordinated and can stop playground ball against
and change direction chest
without falling ● Stands on one foot for a
● Climbs in and out of car few seconds
seat and out crib ● May hop on one foot.
 Functional Mobility Gross Motor Skills
3 – 5 years ● Manages sitting and ● Begins to learn specific skills such
mobility skills safely as swimming and skating
to use standard toilet ● May participate in organized
and to get in and out recreational programs such as
of child’s bed soccer, dance or swimming lessons
● Can pump a playground swing and
● May use a booster
play safely on playground
seat for meals; often
equipment by 4-5 years
does not use stroller
● Gallops and skips
after 4 years of age ● Rides a two wheeled bike with
except for longer training wheel
walks ● Turns a somersault and hops on one
● Manages stairs going foot
up and down with ● Can toss, kick and catch a
alternate feet by 4-5 medium-sized ball with some degree
years. of accuracy
 Functional Mobility Gross Motor Skills

● Rides a two-wheeled bike without training

wheels
● Learns specific skills, such as skating and
swimming
Begins to participate in organized team and
5 - 7 years ●
individual sports activities
● Can complete complex, multistep motor
sequences, such as those required for dance
or martial arts
● Participates in regular physical education
programs at school
 Functional Mobility Gross Motor Skills
● May be able to jog 1-2 miles
● Throws a small ball toward a target, and able to
catch a small ball
7 - 12 years ● May participate in more advanced competitive
sports activities
● Develops specific interests and skills related to
gross motor recreational activities
● Begins to concern self with physical fitness, and
participates in regular physical education
programs at school.
 Functional Mobility Gross Motor Skills

● Continues to concern self with physical

fitness and to participate in regular physical
12 - 18 years education programs at school
● Participation in team sports may decline
during this period
● Some adolescents will advance their skills in
specific sports activities.
Development of Reach,
Grasp and Release of
Objects
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 0 - 2 months
Description of Typical Patterns

● Palmar grasp reflex is strong

● Hands are usually fisted; has visual
regard for hands
● Puts hands in mouth
● Unable to reach
 2 - 4 months
Description of Typical Patterns

● Palmar grasp reflex is strong

● Hands often fisted and clasped together
● Begins to reach for objects, with poor motor
control
● Holds onto objects placed in hands
momentarily with gross fisted grasp
● Often puts hands in mouth
● Frequent visual regard for hands
● Demonstrates full active range of movement
of fingers, wrists, and hands during
spontaneous play, but unable to grasp objects
 4 - 8 months
Description of Typical Patterns

● Palmar grasp reflex weakens; reaches for objects easily

● Picks up and holds objects like a 1” block using primarily an
ulnar, palmar, fisted grasp
● Shakes rattles
● Picks up tiny objects with a raking motion and by trapping the
object between the thumb and the side of the index finger
(scissor grasp)
● Holds larger objects using both hands together, with poor
control
● Transfers objects from one hand to the other
● Proficient at bringing hands to mouth; puts objects in mouth
 8 - 12 months
Description of Typical Patterns

● Palmar grasp reflex fades

● Uses gross fisted grasp on objects using the radial side of the
hand more than the ulnar
● Uses a mature pincer grasp to pick up tiny objects; transfers
objects from one hand to the other
● Uses both hands together to pick up and hold larger objects
● Has voluntary release of objects, although poorly controlled,
and likes to throw, bang, and dump objects
● Does not yet demonstrate a hand preference
● Does not have in-hand manipulative abilities
 1 - 2 years
Description of Typical Patterns

● Uses a mature pincer grasp to hold tiny objects

(object held between the tip or pad of the index finger
and the thumb, with the thumb opposed and the wrist
extended)
● Uses a radial palmar grasp to pick up a 1” cube and a
pronated finger grasp on cylindrical objects
● Has controlled release of objects
● Stacks about five 1” blocks
● Scribbles when given a crayon
 Development of Fine Motor
Dexterity, In-hand Manipulation
& Bilateral Hand Use
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 Age Characteristics

2-4 ● Holds onto objects placed in hands momentarily with

gross fisted grasp
months ● Hands often clasped together

4–8 ● Shakes rattles

● Picks up tiny objects with a raking motion and by
months trapping the object between the thumb and the side
of the index finger (scissor grasp)
● Uses both hands together to hold larger objects
(e.g., a tennis ball or a baby bottle), but with poor
control
● Begins to transfer objects from one hand to the
other
● Proficient at bringing hands to mouth; puts objects
in mouth
 Age Characteristics

8 - 12 ● Transfers objects from one hand to the other

easily
months ● Uses both hands together to pick up and hold
objects such as a tennis ball and a baby bottle
● Has voluntary release of objects, although
poorly controlled, and likes to throw, bang,
and dump objects
● Does not demonstrate a hand preference
● Able to pick up tiny objects with a pincer
grasp; finger feeds self
● Does not have in-hand manipulative abilities
 Age Characteristics

1-2 ● Beginning in-hand manipulation

● Has controlled release of objects and can
years play with shape sorter toys and large
insert puzzles
● Stacks about three to five 1” blocks
● Uses both hands together to carry objects
and claps hands
● Will stabilize with one hand while
manipulating with the other
● Can scribble

continued
 Age Characteristics

1-2 ● Uses a spoon and drinks from a sippy cup

● Tosses a small ball, with little accuracy
years ● Activates more complex cause-effect
push-button toys and pop-up toys
● Turns pages of a book and likes to point isolating
index finger
● Enjoys banging and throwing objects
 Age Characteristics

2-3 ● In-hand manipulation develops and can move

objects from the palm into the fingers without
years help from the other hand
● develops controlled release with shoulder, elbow,
and wrist stability
● stacks about four to seven 1” blocks
● uses both hands together to open simple
containers with lids
● winds wind-up toys, strings large beads; copies a
simple line and a circle
● colors large forms
● snips with scissors
 Age Characteristics

3-4 ● Can do simple fasteners such as large buttons

and uses hands well to dress and undress
years ● Uses mature tripod grasp on a pencil, colors in
the lines, and copies simple shapes
● Strings beads
● Cuts out large shapes with scissors
● Builds with construction toys such as Tinker
Toys and Duplo blocks
● Dresses dolls
 Age Characteristics

4-6 ● Tie shoes

● Prints name
years ● Copies all letters, numbers, and short sentences;
can do fasteners such as buttons, snaps, and
zippers
● Uses fork and knife for cutting; completes
puzzles up to 20 pieces
● Enjoys building with construction toys such as
Lego blocks; opens most packaging
● Manages a computer mouse
 Age Characteristics

7 - 10 years ● Learns cursive writing; develops good dexterity for

constructing models and other craft projects with small
pieces
● Puts together intricate Lego and other types of models;
can create craft projects using tools such as hole
punches, staplers, glue, scissors, and needle and threads
● Can tie knots, cut small shapes with scissors, and make
intricate life drawings
● Proficient and graceful with eating utensils
● Can manage more complex hygiene activities, such as
using nail clippers and styling hair
● Uses computer keyboard and mouse, texting, although
may not use most efficient keyboarding techniques
● May develop a specialized skill, such as playing the piano
or needlework
 Age Characteristics

10 - 18 years ● Keyboarding speed, and hand

use for computer use
becomes more proficient
● Drawing and handwriting
abilities improve
● May develop specific fine
motor skills depending on
interests, such as pursuing
various forms of art,
needlework, and music
● Able to use tools for
completing school science
projects and activities such
as stapler, hole punch,
compass
Reference:
● Mulligan, S. (2014). Occupational therapy evaluation
for children: A pocket guide. Philadelphia: Wolters
Kluwer/Lippincott Williams & Wilkins Health.