6 Months: Pivot Prone

“My 6-month old daughter rocks on her belly and moves her arms all around.  It looks like she is swimming on land!  What is going on while she is playing like that?”

This swimming motion, common during the development of 5-6 month olds, is also known as pivot prone.   The first time you might see something like this would be during a Landau reaction.  The Landau reaction emerges at approximately 3 months as a reflex/postural reaction, allowing the baby to extend against gravity while held at the stomach.  However, by 5-6 months of age, the baby has taken this foundation movement and has developed the strength and flexibility to play with it in a variety of ways while on the floor.  These new sensations and movement keep interest in the activity.

What is happening during this motion?

  • Activation of the back extensor muscles.
  • Functional use of hip extension range.
  • Strengthening and functional use of the gluteus maximus muscles.
  • Using scapular adduction and abduction, allowing the arms to move around with swimming motions.
  • Exploration of anti-gravity arm movement and hip extension movement to create body rocking.
  • Self-initiated creation of sensory feedback.  The rocking provides both proprioceptive and vestibular sensations.
  • Play and experimentation with different positions and movements.
  • Learning about getting attention from actions; this is an adorable stage of development, sure to get all the adults in the room making a big fuss!

 

5 Months: Rolling to Side

 

Q: What happens when a baby brings hands to knees and then weight shifts or looks to the side? 

A: Her whole body rolls to the side and she learns to control it and use it for function.

Around 5-6 months, this little one has learned to initiate some big movements like pushing up onto hands while on her stomach and grabbing knees and feet while on her back.  She is busy reaching and looking around.  Combining foundation skills such as hands to knees and weight shifts, larger movements begin to evolve, like rolling from back to side (otherwise known as supine to sidelying).

What is happening as she rolls from supine to sidelying?

  • Using and refining balance of flexion and extension against more demand.
  • Using and controlling lateral weight shifting.
  • Learning direction specific response of head position and balance responses during lateral flexion.
  • vestibular input from rolling and moving through space.
  • Larger excursion reaching.

 

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.

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 other amazing things that are happening as your baby pulls his toes into his mouth.

  • Activated abdominal muscles!  As you can see from the wrinkles on this baby’s tummy, the core muscles are firing and lifting the legs off the ground.
  • Developing and strengthening downward visual gaze.
  • Grasping and pulling with either one or both arms and 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”

Why I love Using the Gross Motor Function Measure

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 “Why I love Using the Gross Motor Function Measure”

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”