6 Months: Sidelying With Pelvic Femoral Dissociation

Life is so exciting for the six month old; once she learns to roll to the side, it is fun to play in this position.   Beyond fun for the little one, what special things are happening with development at this stage?  After all, play is child’s work.

  • Mastering the balance of flexion and extension in the trunk:  she is able to play in sidelying without falling forward or backward.
  • Increasing shoulder girdle control and stability- allowing propping on one arm to play.
  • Emergence/increasing lower extremity dissociation: one foot can prop to meet the ground and stabilize in this position.  To do this, one leg must be flexed, the other extended while weight is increasingly shifted to the hip that contacts the floor.
  • Foot weight-bearing: bringing the foot to meet the ground and getting some weight on to different parts of the foot in order to prepare for standing.
  • Lateral flexibility and of the trunk/rib cage.
  • Lateral head righting against gravity.

From this position your little one can grab toys to mouth, providing a whole new level of independence for exploration!  All of these movements build the foundation for transitions that come in later months like progressing to side sitting, getting up on all fours and pulling to stand.

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5 Months: Feet to Mouth

Your 5-month-old just learned to lift his feet from the ground and grab them with his hands.  What’s next?  Putting the toes into the mouth, of course!

This is such a sweet phase of development.  Here is a quick review of the amazing things that are happening as your baby pulls her toes to her mouth.

  • Activated abdominal muscles!  You can see activity in the lower abdominals from the wrinkles on this baby’s tummy.  Additionally,  the baby’s pelvis is up off the ground.
  • Developing and strengthening downward visual gaze/capitol flexion.
  • Developing and strengthening balance of postural flexors and extensors, now in advancing to a diagonal motion.
  • Grasping and pulling feet with either one or both hands.
  • Activating quadriceps muscles as the leg straightens.
  • Stretching out hamstrings from the physiological flexion present at birth.
  • Stretching the toes into extension.
  • Foot desensitization (with the heel pounding that happens when the feet hit the floor again).
  • Tactile input from mouthing, grabbing, stretching; preparing the feet for walking.
  • Developing general body awareness.

When a baby discovers this position, they are becoming experts at rolling to their side.

 

14. Strategies For Filling In the ICF/ NDTA Enablement Model

There are hundreds of medical reports in Kiyoshi’s file.   In addition to oligoarticular juvenile idiopathic arthritis (JIA)  he has uveitis and a seizure disorder.  Kiyoshi has severe pain, joint contractures and difficulty moving around.  Medications are not controlling the inflammation, there have been more seizures lately and his foot orthotics are too small.    How do you begin physical therapy decision-making with a child this complex?

The International Classification of Functioning  (ICF) conceptual framework allows you to apply your knowledge  and skills to challenging situations.  It will take a while to sort information into proper categories and edit. However, once this is complete, connections become clear and sound clinical decision-making will follow.    The question I get asked most often about the ICF is , “where do you start?”.  This post will guide you as you fill in the ICF/NDTA Enablement Model categories for the first time. Continue reading “14. Strategies For Filling In the ICF/ NDTA Enablement Model”

Backward Walking: What Are the Benefits?

Do you want to burn extra calories, work on motor coordination and challenge your balance?  Is your knee hurting as you walk up the hill? Turn around and take a part of your walk backwards.  It’s called retro-walking.

Walking in reverse with balance and control comes in handy many times a day.   Where does this happen?

  • As you take a step back to open the front door.
  • Forgot your keys in the house?  You will probably place one foot back while changing direction.
  • During a two person furniture lift, you’re the lucky one who gets to walk backwards!
  • Moving in a crowded kitchen, you back up to let your daughter squeeze by.
  • At the gallery you see a beautiful painting and take a few steps back to take it in.
  • On the playground you balance with a backward stepping response as your friend races by.  This time, you don’t fall.
  • On the soccer field you run in reverse to prevent the other team from scoring.
    Continue reading “Backward Walking: What Are the Benefits?”

9 Resources: Support and Information for Parents of Special Needs Children.

“I was lost at the meeting.  Everyone was bringing up ideas so quickly; I was unsure about everything by half way through.  I didn’t agree and I didn’t want to sign.  It was just overwhelming”.   Melina has been to her first IEP and needs advice from a person who has been in her place.    She is also interested in respite care, a parenting class,  and options for more affordable and accessible housing.   What are the resources for parents of special needs children in the North Bay Area?

Continue reading “9 Resources: Support and Information for Parents of Special Needs Children.”

How to Use the Gross Motor Function Measure (GMFM-66)

Freya is a 6-year-old girl with ataxic cerebral palsy.   She moved to California from Iowa last month and has been prescribed six months of physical therapy.   Freya’s parents are concerned; she has been having difficulty going down the front stairs of their new home.  As her physical therapist, do I have a standardized test that will measure her initial gross motor function?   In six months, how will I determine whether Freya has made statistically significant progress?  

My Gross Motor Function Measure User’s Manual is tattered.  I could not work without the GMFM!    Like all things that are well designed, the creators have taken a complex concept and made it logical and simple.   The GMFM is an evaluative measure that assesses change in motor function over time.  I can test Freya in January,  provide PT 1x/week and then retest in July to determine if she has made significant progress.  In addition, I won’t overlook Freya’s inability to reach across midline while I am heavily focused on her stair skills; the test covers all domains from lying and rolling  up to running and jumping, with each skill being incrementally harder than the last. Continue reading “How to Use the Gross Motor Function Measure (GMFM-66)”

Core Stability: Pushing

 

“My son’s core is so floppy, he really can’t push open the doors when we go to the library.  There is no force through his arms.  Now that he is older, this is stopping him from doing quite a few things”.

Pushing is an essential skill.   To go shopping, a cart must be pushed from aisle to aisle.   A dresser drawer can’t stay open; it must be pushed back into position. We push all day long without much thought about our action, whether it is tidying up the kitchen drawers, pushing a vacuum, going through a revolving door, or moving furniture back into its place. Continue reading “Core Stability: Pushing”