Motor development (1year)

Gross motor development

A. At Birth
1. physiological flexion
2. turns head to side in prone
3. automatic stepping

B. 1 month
1. attempts to lift head In midline

C. 2 months
1.fencer’s posture
2.Astasia
3. abasia
D. 3 months
1.rolling supine to side lying non segmentally
2. beginning midline head control

E. 4 months
1. prone on elbow, head to 90 ,chin tuck
2. hands to

F. 5 months
1.unilateral reaching prone on h
2.prone on extended arm
3.pivot prone posture
4.Beginning intra axial rotation
5.Rolling prone to supine segmentally
6. Head lifting in supine /pull to sit
7.Supine hands to knees and feet, feet to mouth
8.Propped sitting
9. Supine bridging

G. 6 months
1.Rolling supine to prone segmentally
2.Ring sitting unsupported with full trunk extension and high guard
3. Transferring objects hand to hand

H. 8 months
1.Independent sitting with secondary curves
2.Beginning quadruped
3.Beginning pull to standing
I.10 months
1. Creeping
2. plantigrade posture
3. Pulls to standing and lowers self cruising

J. 12 months
1.Pulls to standing through half kneeling
2. Walking independently
Developmental directions
 At birth development
1. Physiological flexion
It is due to developmental direction as flexor tone develops before extensors.
It diminishes in 1st month.
Preterm with decreased or absent physiological flexion born with trunk and limb relatively in
extended position.

2. Turns head to side in prone

It is for survival instinct and influence of ATNR.

3. Automatic stepping
in support standing tilting the child forward produce reflex stepping.
By end of 6 weeks most child lose reflex stepping because mass of infants LE such that it was too
difficult to lift heavy LE.
B. 1 month – attempts to lift head in midline
• At birth full term neonate has physiological flexion – dominates prone position
• hip flexion aspect of physiologic flexion is particularly strong in prone due to anterior pelvic tilt. So
knees underneath him , buttocks up in the air and preventing pelvis to lie flat on surface, Weight is
shifted onto upper chest and face.
• UE adducted by the side of body , hand fisted due to grasp reflex ,elbows caudal to shoulders.
• Physiological flexion diminished over 1st month – infant following more and more into gravity in both
prone and supine.
• In prone hip flexion decreases , buttocks lower down , decrease in anterior tilt but not
completely ,weight shifts away from face caudally to trunk and LE.
• Diminished anterior pelvic tilt is not because of active posterior tilt but loss of physiological flexion.
• As physiological flexion disappears completely –child flat on the floor in prone
• Hips passively extended , preparing for active posterior pelvis tilt -indicate activation and
development of abdominal muscles- trunk flexors and hip extensors – weight shifted all over the body
segment which are in contact with surface.
• No active antigravity control – beginning of cervical extension
• In prone posture lower extremity position – hip abducted, partial extension and ER ,knee semiflexed and
feet DF – position precursor for position of LE in initial standing.- beginning at approximately 5 months of
age.
C. 2 months development
1. Fencers posture
• it is position achieved due to ATNR.

2. Astasia
• lack of weight bearing through the LE which occurs typically during 3 rd and 4th months, is stage of astasia,
meaning without standing.
• It is temporary stage, may not be seen in all children .

3. Abasia
• Absence of automatic stepping is known as abasia, meaning without steps.
D. 3 month development
1. Rolling supine to side lying non segmentally/log rolling
• It is based on neck righting reaction
• The stimulation of proprioceptors in the neck as the child's head is turned actively or passively to one
side cause body to follow in one complete unit without rotation in vertebral coloumn.

2.Beginning midline head control

• Head control in prone – earliest antigravity control.
• Body proportion of head in infant is ¼ th of body length and in adult 1/8 th.
• So relatively heavy and large head.
• Lifting the head is depend on strength of cervical extensors but also cervical flexors as they lengthen
through reciprocal inhibition.
• Ability to use midline cervical extensors to lift the head is a sign of diminishing ATNR and development of
active cervical flexors .
• Waning of ATNR –slight cervical asymmetric extension.
• No balance between cervical flexors and extensors –no chin tuck.
• Active cervical flexors balances this asymmetric extension hence midline head lifting in prone.
• if head is to be up buttock is to be down, weight should be shifted caudally and pelvis must be stabilize for
head and upper trunk lifting. ( pelvis = fulcrum , lever arm =child’s head and upper trunk )
• So, abdominal muscle recruitment is important to hold pelvis in posterior tilt and stabilization of it.
• With the help of this child able to lift head app. 2 months of age.
• At 3 months baby’s head is at 45 or greater angle with surface – head control mostly by cervical extensors
muscles.
E.4 months development

1. POE, head to 90 , chin tuck - 1 st UE weight bearing posture

• For prone on elbow or forearm 3 requisites .
1.Stabilization of pelvis
2.Head lifting with cephalocaudally progressing antigravity extensor control
3.Movement of UE out of the neonatal position.

• By 4 months child lift head to 90 vertical but chin juts forward slightly with neck hyperextension
during early attempts of POE or POF
• Upper thoracic extensors begin to strengthen and gain antigravity control.
• But one element of head control is missing, it is activation and strengthening of antigravity cervical
flexors to balance antigravity cervical extensors.

• Chin tuck require 3 developmental occurrences.

1.Activation and strengthening of cervical flexors
2.Reduction of ATNR
3.Activation and strengthening of serratus anterior muscle
• TV shoulders
• Weak serratus not able to protract the shoulders, so child UE not worked into surface.
• Shoulder elevated , neck hyperextend ,infants occiput resting on post cervical soft tissues and chin
jutting forword .face is not at 90 vertical.
• No active head control, shoulder elevated to side of the head close to the ears give passive head
control
• Persistence =interfere with antigravity head control, lateral head righting swallow, talk and breath due
to cervical hyperextension.
• 3rd element for POE is forward position of elbow.
• In FT neonate UE adducted ,extended and or under the body – mech. Disadvantage in trying to lift
upper trunk and head.
• Shoulder control starts to develop at 2nd month – when infant 1st attempting to lift head.
• Now, infant gradually abducts and flexes shoulders, bringing elbows underneath his body forward ,
underneath shoulder or just anterior to it to bear weight on elbow on forearm when he lifts the head it
causes development of scapulohumeral elongation.
•
• Scapulohumeral elongation :
• Elongation of the axillary region as humerus is flexed and abducted away from the body and therefore
away from the scapulae.
• Without the scapulohumeral elongation, the child elbow will not under the shoulder for prone on
elbow posture.
• Failure – interfere with reaching out in space.

• Progression in POE : (in sequence)

• Stable POE position –translate position in movement with stability at prox. Joint i.e. shoulder
• Shifting weight side to side ( increasing amount of weight bearing on each UE as weight shifted to that
side)
• Shifting weight in all direction(forword, backward, diagonally)
• Reaching for toys – 1st attempt fails as child shifts his weight onto the side to which he is looking – with
practice visually directed reaching.

• No weight shifting – no controlled mobility function for open chain (reaching) and closed chain
propulsion.
• Weight shifting importance:
1. Feature of all milestone posture after stability of each postures
2. Critical for development of equilibrium and tilting responses for maintaining the balance,
functional use of UE.
3.Causes elongation of muscles specially lateral trunk muscles on the side that is weight bearing or
bearing most of the weight and shortening of lateral trunk on the side of free UE with lateral
bending or flexion to that side.
4. introduces vestibular stimulation which is under his control
5. in full UL weight bearing ,increases joint compression on particular side – facilitates Recruitment of
motor units in the working muscles.
6. in POE helps to supinate forearm of the side to Which weight is shifted, and opposite side
Forearm Pronate. – proprioceptive feedback from this reciprocal pronation and supination
helps to active forearm supination. Without ability to supinate – no ability to reach ,grasp,
visually engage the object. Dorsum of the hand blocks view of object grasped
7. lack of supination- food spillage
2. Hands to midline
Active contraction of pectorals with reciprocal inhibition of rhomboids and inhibition of ATNR helps for this.
Pectoral muscle in synergy with serratus anterior and with elongated rhomboids protract shoulders.

F. 5 months
1. Unilateral reaching POE
as child practices weight shifting in POE ,he tries for reaching for a toy from this position.
1st attempts for this is fails as child shifts his weight onto to the side to which he is looking
By trial and error child learns to shift weight to one elbow and forearm while looking in the opposite direction ,
establish visually directed reaching.

2. Prone on extended arm

Now baby begins to lift himself farther from surface.
He pushes himself up into POEA ,working his opens hands into the surface ,using triceps to extend his elbows and
serratus to protract and stabiles the shoulder.
The anterior thoracic muscle must elongated.
He progresses with weight shifting and u/l reaching .
• Posterior weight shifting , may cause himself to move backward in this position , increase
scapulohumeral elongation.
• Continue to shift his weight backward over the knees and into the quadruped posture with weight on
hands.
• With enough force he may come up in a push up position and child may progress for quadruped
position.

3. Pivot prone posture

it contribute for pelvic and scapular mobility.
This position uses cephalocaudally progressing extension to extend childs neck, midline trunk and LE.
Pelvis is in anterior tilt, with hips hyperextended.
UE is in high guard position with scapulae adducted by rhomboid muscle.
UL is horizontally abducted at the shoulders and flexed at the elbows.
This posture enhance the trunk extension and anterior musculature must elongated.
As child gain stability in the posture, he playfully moves alternately between pivot prone and POE and
retraction in pivot prone.
Pelvic move between posterior and anterior tilt and child pivots his body in a circle as he kicks his legs or
quikly alternates between these postures.
4. Beginning intra axial rotation.
Neck righting reaction gradually diminishes over the time by body righting reaction.
Body righting reaction is a predominant factor for intra axial rotation.
When the head is rotated to one side, the body reacts to proprioceptive stimulus to the neck by following the
direction of head turning, thus rolling towards that side but the movement within vertebral column is
segmental.
This segmental rolling rotates within the body axis, that is vertebral column.

5. Rolling prone to supine segmentally.

Before volitional attempts baby may roll accidentaly
Accidental rolling is due to – 1. baby pulls his knees underneath him so buttocks high in air, and if COM
increase sufficiently baby rolls.
2. Spinal extension progress caudally. So in POE and POEA COM higher through lifting head and upper trunk.
The upper top is heavy and baby rolls.
3. It is due to influence of body righting reaction.
By trial and error baby finally learn how to roll.
6. Head lifting in supine/ pulls to sit
In pull to sit, head should be in plane with body. There should be no head lag.
In full term newborn due to physiological flexion ,neck is in slight cervical flexion with head in midline, elbow
flexed, posterior tilted pelvis, hip flexed and adducted, knee flexed, feet in air not touching the surface, loosly
fisted hand which may frequently open.
As at end of 1st month, physiological flexion disappears head falls away from midline to side, that it no longer
supported by physiological flexion.
With active cervical flexor control, head is placed in plane with body and when it progress it lead with head
whenever stimulus is given for pull to sit. LE is flex at hip actively during stimulus.

7. Supine hands to knees and feet, feet to mouth

Control of antigravity flexors with reciprocal lengthening of antagonist extensor muscles helps to lift LE from
surface.
1st progress with feet to feet contact then hand to ipsilateral knee and foot progress to contralateral knee and
foot.
It helps to learn body image and body scheme.
Flexion of hip to bring feet towards hands and head strengthen abdominals and hip flexors. Active contraction of
abdominals causes posterior pelvic tilt and lengthening of gluteal maximus and proximal hamstring.
• Hands to knees and feet progress to feet to mouth.
• Child interested in oral stimulation at this stage, so in feedforward anticipation he puts toes
to mouth.
• It helps to develop body image and helps for cognitive development, form and shape
perception.

10. Propped sitting

Child is sitting without external support with either being held or backrest.
He propped with UE, with weight shifted forward and hands in contact with surface.
His open hands placed on floor in front of him and LE out in front of him.
UE plays weight bearing role.
2 hands and buttock form tripod base with larger and stable BOS.
As child feels secure in this posture , he starts to rotate neck to look around.
Progravity used – contraction of hip flexors for stability.
G. 6 months
1. Rolling supine to prone segmentally – intraaxial rotation
Initially it is accidental rolling.
the COM is increased through lower trunk when child is attempting to bridge and he roll as he pushes
harder into surface with one foot (contralateral foot of side being rolled).
By trial and error and strong body righting reaction, child learns to roll.
It helps to dissociate between right and left extremity and extremity and head.
Rolling supine to prone with leading UE require scapulohumeral elongation.

2. Ring sitting unsupported with full trunk extension and high guard
As child trunk extension become stronger he attempts for ring sitting.
The name itself is due to position of LE.
Child is sited erect with pelvis perpendicular to floor.
Child has adequate spinal extension to resist pull of gravity in sitting but he feels less stable actually he
is, so he uses high guard position of UE.
• in high guard position ,retraction of shoulder is similar to pivot prone position.
and contraction of rhomboid increase activity in posterior trunk muscle.
LE is place such that – hip is flexed and ER ,knee flexed, feet supinated touching each other.

3. Transferring objects hand to hand

H. 8 month
1.Independent sitting with secondary curve
Due to full antigravity extension of back and completion of secondary curves( cervical and lumbar lordosis)
child is able to sit independently and in and out of various sitting postures by intra axial rotation.

2. Beginning quadripod
Stable quadripod position require stable hip and shoulder and stable trunk.
Stable hip shoulder can be achieved by muscle co contraction around the joint and stable trunk meaning
trunk flexors – extensor balance for flat back in quadripod posture.
During 1st attempt for quadripod as abdominal muscles are not developed there is increase lumbar
lordosis. Also progravity of hip flexors contribute for this.
Development of abdominals muscle with posterior tilt of pelvis and balance between trunk and lumbar
flexor extensors helps for flat back in quadripod.
BOS is wide initially due to excessive hip abduction which may interfere with lateral weight shifting for
unilateral weight bearing.
As child tries to shift weight posteriorly , UE is in closed chain and helps to scapulohumeral elongation.
3. Beginning pull to standing.
Initially child uses strength of UE and LE is passive.
Once he stands ,holds crib rails and bounces but he is not able to sit down as it require high eccentric
control of hip and knee.
He frustrate and let go the crib rail and drop to sitting.
He starts to cry and gets attention so he repeat the sequence.

I.10 months
1. Creeping
2. Pulls to standing and lowers self cruising
As child learns pulls to stand, child play for longer periods going back and forth between floor and
furniture, squatting and rising to stand repeatedly and also moves in and out of various posture.
Now child begins stepping sideways while holding onto furniture, called as cruising.
He is able to work back and forth and make his way around the room.
Anterior – posterior alignment is improving with decrease hip knee flexion.
While standing at furniture child is able to lift one or other hand from support, sometimes rotate his
trunk to one side or other with balance.
While reaching for nest piece of furniture child may briefly stands and take one two steps without
support from either extremity.
This milestone develop and strengthen hip abduction adduction and inversion eversion of ankle.
Plantar grasp reflex is positive at this age, so child curls his toes with support standing.
Similarly child progress to independent standing for brief period with UE in high guard position to
increase trunk stability.
J. 12 month
1. Pulls to standing through half kneeling/ kneel standing
The BOS is relatively wide in tall kneeling as COM is away from the floor.
To achieve half kneeling child must shift his weight to one side elongating trunk on that side, so
unweighted limb is placed in forward position and child puts his foot flat on floor.
But these transition require intra axial rotation.
At this age child also adapt with getting down with control.
Half kneeling uses hip - knee extensors to raise himself against gravity.
Childs UE is helpful only to maintain balance.
With practice child is able to do controlled and fast movement.