Motor Development DTW

1. Normal Motor Development
   1. Key Points of Normal Motor Development
   2. Management of Normal Motor Development
2. Body-Kinesthetic Intelligence
   1. Key Points of Body-Kinesthetic Intelligence
3. Developmental Coordination
   1. Key Points of Developmental Coordination
   2. Clinical Guides for Developmental Coordination
   3. Definitions of Developmental Coordination
   4. Differential Diagnosis / Comorbid Conditions of Developmental Coordination
   5. Management of Developmental Coordination
4. Sensorimotor Integration
   1. Key Points of Sensorimotor Integration
   2. Clinical Guides for Sensorimotor Integration
   3. Definitions of Sensorimotor Integration
   4. Differential Diagnosis / Comorbid Conditions of Sensorimotor Integration
   5. Management of Sensorimotor Integration
5. Spatial Intelligence
   1. Key Points of Spatial Intellgence
6. Resources for Parents
7. Tools
8. References

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• Flexion and extension: Healthy infants are born able to extend and flex and to move their bodies from side to side. What the newborn lacks is the postural control necessary to assume increasingly advanced developmental positions against gravity and the coordination to use a wide variety of movement patterns to accomplish a task. Postural control develops from the head toward the feet. Gradually, the infant coordinates movement in a predictable sequence-gaining head, neck, then trunk, and finally leg control for exploration and expression. Through play and social interaction, infants learn to organize these movements for practical and intentional purposes.
  Healthy infants are born able to extend and flex and to move their bodies from side to side. What the newborn lacks is the postural control necessary to assume increasingly advanced developmental positions against gravity and the coordination to use a wide variety of movement patterns to accomplish a task. Postural control develops from the head toward the feet. Gradually, the infant coordinates movement in a predictable sequence-gaining head, neck, then trunk, and finally leg control for exploration and expression. Through play and social interaction, infants learn to organize these movements for practical and intentional purposes.
• Head control: Locomotion begins with head control at two months or at about four months, when a baby first succeeds in turning over on his stomach.
  Locomotion begins with head control at two months or at about four months, when a baby first succeeds in turning over on his stomach.
• Crawling: The onset of locomotion has been heralded as the "psychological birth" of the child . With the onset of locomotion in the form of crawling, the infant is more autonomous, can pursue goals quite separate from the mother's, and explore all the fascinations of the world around them . It has been argued that this is one of life's major milestones bringing with it a revolution in social-emotional development, visual-spatial perception and cognition . The infant's individualism now fully emerges; her distinct motivations, attachments (through proximity seeking) and place in the family can be more fully expressed with the onset of locomotion. Infants and mothers report more expressions of anger and mothers attribute a greater sense of goal-focused behavior and responsibility to their infant's with the onset of locomotion .Some babies, however, never creep or crawl. They want to be able to see everything, so they discover a way to manage locomotion by maintaining a sitting position, extending one leg, and hitching along. With crawling also comes depth perception. Studies using the "visual cliff" have suggested that the experience of locomotion is what allows the developing infant to appreciate depth and the risks of heights.
  The onset of locomotion has been heralded as the "psychological birth" of the child . With the onset of locomotion in the form of crawling, the infant is more autonomous, can pursue goals quite separate from the mother's, and explore all the fascinations of the world around them . It has been argued that this is one of life's major milestones bringing with it a revolution in social-emotional development, visual-spatial perception and cognition . The infant's individualism now fully emerges; her distinct motivations, attachments (through proximity seeking) and place in the family can be more fully expressed with the onset of locomotion. Infants and mothers report more expressions of anger and mothers attribute a greater sense of goal-focused behavior and responsibility to their infant's with the onset of locomotion .Some babies, however, never creep or crawl. They want to be able to see everything, so they discover a way to manage locomotion by maintaining a sitting position, extending one leg, and hitching along. With crawling also comes depth perception. Studies using the "visual cliff" have suggested that the experience of locomotion is what allows the developing infant to appreciate depth and the risks of heights.
• Walking: It takes some time after creeping and crawling before a baby is able to stand up and take her first steps. The timing varies from child to child.
  It takes some time after creeping and crawling before a baby is able to stand up and take her first steps. The timing varies from child to child.
• 2-year visit: At 2 child should: Walks forward: slightly bent, Walks backward: 10 feet, Runs: changing direction, Climbs: out of crib (2.5 years), Jumps: both feet off floor, Jumps down: step with both feet, Stairs, up: 1, one step at a time, Stairs, down: 4, one step at a time, Stands on one foot: tries, Kicks: kicks ball 6 feet, Throws: Throws 5 feet.
  At 2 child should: Walks forward: slightly bent, Walks backward: 10 feet, Runs: changing direction, Climbs: out of crib (2.5 years), Jumps: both feet off floor, Jumps down: step with both feet, Stairs, up: 1, one step at a time, Stairs, down: 4, one step at a time, Stands on one foot: tries, Kicks: kicks ball 6 feet, Throws: Throws 5 feet.
• 3-year visit: At 3 child should: Walks forward: swings arms, Runs: alternating arms, Climbs: high equipment, Jumps: 26-30 inches from 1 foot; 6 inches from both feet, Jumps down: 16 inches, lands on 1 foot first, Stairs, up: 4, without rail, alternating, Stairs, down: alternating, no rail, Stands on one foot: 1 second on one foot, Hops: 3 hops in place, Throws: Bounce, overhand, Catches: straight arms, Pedals: 10 feet, tricycle.
  At 3 child should: Walks forward: swings arms, Runs: alternating arms, Climbs: high equipment, Jumps: 26-30 inches from 1 foot; 6 inches from both feet, Jumps down: 16 inches, lands on 1 foot first, Stairs, up: 4, without rail, alternating, Stairs, down: alternating, no rail, Stands on one foot: 1 second on one foot, Hops: 3 hops in place, Throws: Bounce, overhand, Catches: straight arms, Pedals: 10 feet, tricycle.
• Trigger Questions: 1)How does _____ get from one place to another? 2)How does the child ambulate into the examination room? 3)How does he or she get up on the examination table? 4)How does she or he perform any gross motor tasks the clinician requests, such as standing on tiptoe, standing on one foot, walking backward, walking in a line, skipping, and running? 5)Can he or she perform tasks requested without a model?
  1)How does _____ get from one place to another? 2)How does the child ambulate into the examination room? 3)How does he or she get up on the examination table? 4)How does she or he perform any gross motor tasks the clinician requests, such as standing on tiptoe, standing on one foot, walking backward, walking in a line, skipping, and running? 5)Can he or she perform tasks requested without a model?
• regular intervals: Ideally as part of regular health care visits within the child's medical home.
  Ideally as part of regular health care visits within the child's medical home.
• hand-to-mouth consoling.: This is one of the ways an infant consoles himself/herself when irritable or distressed. Allowing the infant this opportunity builds his/her confidence in independence. Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another).
  This is one of the ways an infant consoles himself/herself when irritable or distressed. Allowing the infant this opportunity builds his/her confidence in independence. Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another).
• infant visual abilities.: Use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Emphasize the relevance of this 'looking schemata' to later cognitive skills. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby.
  Use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Emphasize the relevance of this 'looking schemata' to later cognitive skills. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby.
• normal body parts: Parents often have many questions about whether their baby is normal. This is a chance to bring out those concerns, reassure, and start correct labels of genitalia.
  Parents often have many questions about whether their baby is normal. This is a chance to bring out those concerns, reassure, and start correct labels of genitalia.
• unstable respirations, color and jerky movements: Parents notice and worry about these normal physiological instabilities.
  Parents notice and worry about these normal physiological instabilities.
• hand to mouth consoling.: This is one of the ways an infant consoles himself/herself when irritable or distressed. Allowing the infant this opportunity builds his/her confidence in independence. Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another).
  This is one of the ways an infant consoles himself/herself when irritable or distressed. Allowing the infant this opportunity builds his/her confidence in independence. Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another).
• Head control: Locomotion begins with head control at two months or at about four months, when a baby first succeeds in turning over on his stomach.
  Locomotion begins with head control at two months or at about four months, when a baby first succeeds in turning over on his stomach.
• fine-motor development: Use the baby's rapid development of reaching and grasping abilities to demonstrate and explain the beginning sequence of fine-motor development (pincer grasp) and visual-motor coordination. For example, offer the child a Cheerio in the palm of your hand. At this age, the infant uses the thumb and all fingers in a raking, somewhat uncoordinated manner. Over the next three months, with increasing neuro-maturation and fine-motor coordination, the infant will soon use the thumb and forefinger in a raking motion and the thumb and forefinger overhand, which is called a "neat pincer grasp." This occasion also provides an opportunity to tell parents to keep small objects away from a child who can now pick them up and choke on them. It also means the child is becoming more independent and can get things himself/herself rather than relying on others. This ability often results in reduced crankiness on the part of the baby. Also try holding out a tongue blade to the baby. The child's reach will be the same whether the stick is oriented horizontally or vertically, but over the next three months, the infant's attempts to grasp the stick will involve greater visual-motor coordination.
  Use the baby's rapid development of reaching and grasping abilities to demonstrate and explain the beginning sequence of fine-motor development (pincer grasp) and visual-motor coordination. For example, offer the child a Cheerio in the palm of your hand. At this age, the infant uses the thumb and all fingers in a raking, somewhat uncoordinated manner. Over the next three months, with increasing neuro-maturation and fine-motor coordination, the infant will soon use the thumb and forefinger in a raking motion and the thumb and forefinger overhand, which is called a "neat pincer grasp." This occasion also provides an opportunity to tell parents to keep small objects away from a child who can now pick them up and choke on them. It also means the child is becoming more independent and can get things himself/herself rather than relying on others. This ability often results in reduced crankiness on the part of the baby. Also try holding out a tongue blade to the baby. The child's reach will be the same whether the stick is oriented horizontally or vertically, but over the next three months, the infant's attempts to grasp the stick will involve greater visual-motor coordination.
• Shaking and throwing: Reframe the child's actions as acts of exploration rather than as deliberate attempts to make a mess. For example, parents often discuss the behavior of throwing food off a high chair, some parents responding by not allowing the child to feed himself/herself. Commiserate about messiness, but also reframe to parents why one-year-olds throw things. Shaking and throwing are the child's way of exploring objects to discover what they can do. Discuss alternative strategies for balancing the child's desire to learn through exploration against the parents' reasonable wish for less mess. Suggest that parents give the child one piece of finger food at a time, put a plastic sheet under the high chair, or tell the child which objects can be thrown and which cannot (e.g."Balls are for throwing, Cheerios are for eating.").
  Reframe the child's actions as acts of exploration rather than as deliberate attempts to make a mess. For example, parents often discuss the behavior of throwing food off a high chair, some parents responding by not allowing the child to feed himself/herself. Commiserate about messiness, but also reframe to parents why one-year-olds throw things. Shaking and throwing are the child's way of exploring objects to discover what they can do. Discuss alternative strategies for balancing the child's desire to learn through exploration against the parents' reasonable wish for less mess. Suggest that parents give the child one piece of finger food at a time, put a plastic sheet under the high chair, or tell the child which objects can be thrown and which cannot (e.g."Balls are for throwing, Cheerios are for eating.").
• walking: Parents may talk about their newly mobile children as 'into everything,' 'stubborn,' or simply 'bad.' Many parents of one-year-olds misinterpret their child's behaviors as willful attempts to undermine parental authority. Reframe newfound mobility in terms of the increased opportunities for learning it offers. To demonstrate, give the baby a pop-up toy or busy-box to play with. Discuss strategies the child uses to figure out how to get the toy to perform. Babies who use a variety of actions like banging, shaking, and poking have developed more ways to use objects and to extract meaning from them than children who use fewer strategies, broadening their understanding of how the world works.
  Parents may talk about their newly mobile children as 'into everything,' 'stubborn,' or simply 'bad.' Many parents of one-year-olds misinterpret their child's behaviors as willful attempts to undermine parental authority. Reframe newfound mobility in terms of the increased opportunities for learning it offers. To demonstrate, give the baby a pop-up toy or busy-box to play with. Discuss strategies the child uses to figure out how to get the toy to perform. Babies who use a variety of actions like banging, shaking, and poking have developed more ways to use objects and to extract meaning from them than children who use fewer strategies, broadening their understanding of how the world works.
• stranger anxiety: Many children are upset when they get into the room with strangers. Model how to slowly approach the child, paying attention to a toy or shoes rather than making direct eye contact, using your voice as a distraction. If that approach is unsuccessful, you can point to your own frustration and note how other family members or friends who see the child infrequently may feel rejected by the child. At 15 months, you often will not need to do anything to provide an example of the child's growing autonomy.
  Many children are upset when they get into the room with strangers. Model how to slowly approach the child, paying attention to a toy or shoes rather than making direct eye contact, using your voice as a distraction. If that approach is unsuccessful, you can point to your own frustration and note how other family members or friends who see the child infrequently may feel rejected by the child. At 15 months, you often will not need to do anything to provide an example of the child's growing autonomy.
• climbing and exploration: Many children will demonstrate how actively they like to explore by trying to climb onto the exam table, touching equipment, or trying to leave the room. Empathize with parents, reassuring them that their child's behavior is normal, as are their frustration, embarrassment, or anger. You can explain that a toddler's autonomy struggles often feel as if the child is 'refusing to listen.' Learn how they respond to them.
  Many children will demonstrate how actively they like to explore by trying to climb onto the exam table, touching equipment, or trying to leave the room. Empathize with parents, reassuring them that their child's behavior is normal, as are their frustration, embarrassment, or anger. You can explain that a toddler's autonomy struggles often feel as if the child is 'refusing to listen.' Learn how they respond to them.
• Difficulty in motor skills: DCD has a varied and individualized pattern of symptoms which may include: slower reaction time, difficulty with timing of movements, difficulty with force control, limited ability to adapt motor motions based on environmental demands, shaky or agitated movements, poor posture, poor balance, reliance on visual input to maintain balance, poor integration of sensory information, difficulty in bimanual coordination.
  DCD has a varied and individualized pattern of symptoms which may include: slower reaction time, difficulty with timing of movements, difficulty with force control, limited ability to adapt motor motions based on environmental demands, shaky or agitated movements, poor posture, poor balance, reliance on visual input to maintain balance, poor integration of sensory information, difficulty in bimanual coordination.
• perinatal complications or at-risk: Low APGAR, low-birthweight, prematurity, or birth complications such as breech birth, c-section, use of forceps or vacuum extraction (Cermak et al., 2002).
  Low APGAR, low-birthweight, prematurity, or birth complications such as breech birth, c-section, use of forceps or vacuum extraction (Cermak et al., 2002).
• information processing deficits: It is not clear if information processing deficits are a cause or effect of DCD.
  It is not clear if information processing deficits are a cause or effect of DCD.
• Mild forms may resolve: It is unclear why some cases resolve and others do not. Likely the multiple developmental forces - neurological, social, environmental, genetic, psychological -- impacting individual trajectories play a large role in the multifinality of outcomes.
  It is unclear why some cases resolve and others do not. Likely the multiple developmental forces - neurological, social, environmental, genetic, psychological -- impacting individual trajectories play a large role in the multifinality of outcomes.
• social and behavioral problems: Withdrawl, isolation, docility, external locus of control
  Withdrawl, isolation, docility, external locus of control
• Neurological disorders: Can be distinguished from developmental coordination disorder because there is specific and identifiable neural damage and abnormal findings on neurological examination.
  Can be distinguished from developmental coordination disorder because there is specific and identifiable neural damage and abnormal findings on neurological examination.
• attention and learning disabilities: Clinical reports and some non-randomized research studies have long reported co-morbidity between DCD and attention problems. However, more recent research with normative school-age children has not found a link between executive functioning (necessary for learning and attention) and motor skills
  Clinical reports and some non-randomized research studies have long reported co-morbidity between DCD and attention problems. However, more recent research with normative school-age children has not found a link between executive functioning (necessary for learning and attention) and motor skills
• Treatment for DCD: Task oriented interventions are favored and have the most empirical support.
  Task oriented interventions are favored and have the most empirical support.
• sensory information: May include sight, touch, smell, sound, taste, vestibular or proprioceptive information, all of which may vary by intensity, duration or location.
  May include sight, touch, smell, sound, taste, vestibular or proprioceptive information, all of which may vary by intensity, duration or location.
• Praxis or Dyspraxia: General terms referring to motor planning deficits that are primarily developmental in origin; this terminology is often used by occupational therapists.
  General terms referring to motor planning deficits that are primarily developmental in origin; this terminology is often used by occupational therapists.
• Sensory integrative-based dyspraxia, Somatodyspraxia, or Bilateral integration and sequencing disorder: Sensory deficits are central to the motor deficits in sensory integrative-based dyspraxia. In somatodyspraxia, sensory deficits are a component of the motor deficits but other factors may also play a role. In the case of BIS, motor deficits are primarily due to problems in vestibular and proprioceptive sensory integration.
  Sensory deficits are central to the motor deficits in sensory integrative-based dyspraxia. In somatodyspraxia, sensory deficits are a component of the motor deficits but other factors may also play a role. In the case of BIS, motor deficits are primarily due to problems in vestibular and proprioceptive sensory integration.