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== Introduction ==
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/krista-eskay/Krista Eskay]<br>
The most critical period for developmental growth occurs during early childhood.  Development refers to changes in abilities and skills that improve daily functioning.  Meaningful changes in development facilitate a highly dependent child to become an independent individual.  Development follows general principles that are universal to all human beings: <ref name=":1">Singh R, Bisht N, Parveen H. [https://www.researchgate.net/publication/334125792_Principles_Milestones_and_Interventions_for_Early_Years_of_Human_Growth_and_Development_An_Insight Principles, milestones and interventions for early years of human growth and development: an insight]. Int J Curr Microbiol Appl Sci. 2019;8(6):181-90.</ref>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


* Change: A progressive series of changes occurs during development. These changes are both qualitative and quantitative.
== Introduction  ==
One of the most critical periods for developmental growth occurs during early childhood. Development refers to changes in abilities and skills that improve daily functioning. Meaningful changes in development facilitate a highly dependent child to become an independent individual. Development follows general principles that are universal to all human beings:<ref name=":1">Singh R, Bisht N, Parveen H. [https://www.researchgate.net/publication/334125792_Principles_Milestones_and_Interventions_for_Early_Years_of_Human_Growth_and_Development_An_Insight Principles, milestones and interventions for early years of human growth and development: an insight]. Int J Curr Microbiol Appl Sci. 2019;8(6):181-90.</ref>


* Continuous Process: Throughout the life of an individual there is continuous development. Each stage of development builds the groundwork for the sequential stage.
* '''Change''': A progressive series of changes occur during development. These changes are both qualitative and quantitative.


* General to Specific: Movement patterns begin with general actions progressing to specific. Large muscle movements precede refined muscle movements.
* '''Continuous Process''': Throughout the life of an individual there is continuous development. Each stage of development builds the groundwork for the next stage.
<span class="_ _0"></span>
*<span class="_ _0"></span>'''General to Specific''': Movement patterns begin with general actions progressing to specific. Large muscle movements precede refined muscle movements.<span class="_ _0"></span>
* '''Sequential''': Development always follows certain sequences and occurs in an orderly manner.<span class="_ _0"></span>
* '''Predictable''': Common features and traits occur in every stage that have predictable, orderly patterns.<span class="_ _0"></span>
* '''Heredity and Environment''': Development is a product of family, culture and social influences. All of these attributes contribute simultaneously to the individual's development.


* Sequential: Development always follows certain sequences and in an orderly manner.
* '''Maturation''': Development relies on learning and maturation. Maturation refers to the biological growth or changes that naturally occur over time. These changes take place in the brain and nervous system, and facilitate development in thinking and motor skills. The brain has to develop or mature enough to allow for the next skills in the sequence to dev<span class="_ _0"></span>elop.
<span class="_ _0"></span>
* '''Individual Rates of Growth''': Development follows usual sequences and patterns, but each individual will develop at their own rate.<span class="_ _0"></span>
* '''Specific Directions''':


* Predictable: Common features and traits occur in every stage that have predictable, orderly patterns.
# ''Cephalocaudal'': Infants develop by first controlling their head before being able to control their arms and legs.  Development takes place in a downward direction with the arms preceding the legs.
<span class="_ _0"></span>
# ''Proximodistal'': Infants learn to control the centre of their body before the periphery; the head and trunk before the arms and legs.<ref name=":1" />


* Heredity and Environment: Development is a product family, culture and social influences.   All of these attributes contribute simultaneously to the individuals development.
=== Flexed Posture ===
* Maturation: Development relies on learning and maturation. Maturation refers to the biological growth or changes that naturally occur over time. These changes take place in the brain and nervous system and facilitate improvement in thinking and motor skills. The brain will have to be developed or matured enough to allow for the next sequential skills.
In infants born at term, range of motion (ROM) of the hips and knees is limited by muscle tightness and increased muscle tone (stiffness) in the lower limb flexor muscles. This flexed posture occurs because there is restricted space in the uterus in the last weeks of intrauterine life. This position is referred to as neonatal hip flexion contracture.<ref name=":0">Von Hofsten C, Rosander K. [https://www.researchgate.net/publication/325278860_The_Development_of_Sensorimotor_Intelligence_in_Infants The development of sensorimotor intelligence in infants]. Advances in child development and behavior. 2018 Jan 1;55:73-106.</ref>
* Individual Rates of Growth: Development follows usual sequences and patterns, but each individual will develop at their own rate.  
* Specific Directions:


# Cephalocaudal: Infants develop by first controlling their head before being able to control their arms and legs.  Development precedes in a downward direction with the arm preceding the legs.
* During periods of relative quietening of movement:
# Proximodistal: Infants learn to control the centre of their body before the periphery; the head and trunk before the arms and legs.<ref name=":1" />
** The hips are flexed, abducted and laterally rotated and the infant lies with their feet lifted up off the supporting surface
 
** The knees cannot be fully extended and when passively extended they recoil back to a more flexed position
 
* Newborn kicking actions:
 
** Characterised by a decrease in the range of hip flexion, along with some extension of the knee
for  further  achievement  and  the proThe newborn infant arrives in the extra-uterine world with numerous movement behaviours that support their survival, interaction with the environment and ability to learn from experience. Movement behaviours present at birth are organised as sensorimotor synergies which can be adapted to changing circumstances and events in the environment. The newborn has three survival behaviours: rooting, the suck-swallow-breathe synergy, and turning the head to free the airway.
** The ankle remains in dorsiflexion with the toes in flexion. This relative extension of the hip and knee is followed by a return to the more flexed resting position<ref name=":0" />
 
These movement behaviours are organised as perceptual-motor synergies  (also referred to as motor patterns) which can be adapted to changing circumstances and events in the environment. Previously these synergies were described as reflexes, but more recent studies have shown that these synergies involve complex patterns of movements adapted to ongoing changes in the environment. <ref name=":0">Von Hofsten C, Rosander K. [https://www.researchgate.net/publication/325278860_The_Development_of_Sensorimotor_Intelligence_in_Infants The development of sensorimotor intelligence in infants]. Advances in child development and behavior. 2018 Jan 1;55:73-106.</ref>
 
. Rooting
 
Rooting refers to the infant's tendency to turn their head towards a touch stimulus, applied to the area around the mouth which facilitates turning towards and latching onto the nipple for feeding.
 
Traditionally rooting was considered to be a stereotypical response to a specific stimulus in other words, it was thought to be a simple reflex. But research has shown that the rooting response adapts to circumstances, for instance, rooting is not elicited when babies or infants touch themselves. [2]
 
The motion of the infant's head and mouth occurs simultaneously with whole-body movements suggesting rooting is more than a reflex.<ref name=":0" /><ref>Rochat P, Hespos SJ. [[Differential rooting response by neonates: Evidence for an early sense of self]]. Infant and Child Development. 1997 Sep 1;6(3‐4):105-12.</ref>
 
2. Sucking
 
Sucking
 
Sucking is another newborn behaviour that involves a complex interaction of muscle contractions that are adaptable to the environment. Babies adjust sucking pressure based on the flow of milk by sensing the upcoming flow. “Craig and Lee (1999) found that neonates adjusted their sucking action in a precise and prospective way indicating that they anticipated the upcoming flow of milk.” <ref name=":0" />
 
Sucking has two phases
 
creating a temporary vacuum in the mouth region
 
releasing the milk from the nipple[1
 
Sucking adaptation can also be seen when newborns suck for comfort instead of food.<ref>Lau C. [https://www.researchgate.net/publication/281818049_Development_of_Suck_and_Swallow_Mechanisms_in_Infants Development of suck and swallow mechanisms in infants]. Annals of Nutrition and Metabolism. 2015;66(Suppl. 5):7-14.</ref>
 
3. Head turning to keep airway clear
 
The ability to lift and turn head to keep airway clear is another perceptual-motor synergy present from birth. [2]
 
When placed face-down on a supporting surface newborn infants will lift and turn their heads to clear the airway. [2]
 
Lifting and turning the head involves not only the neck muscles but also requires some adjustments in the upper extremities and trunk muscles to provide some stability to support the neck movements.[1]


=== Muscle Synergy ===
Muscle synergies refer to consistent muscle coordination patterns that accurately generate a specific motor action.<ref>Goudriaan M, Papageorgiou E, Shuman BR, Steele KM, Dominici N, Van Campenhout A, Ortibus E, Molenaers G, Desloovere K. [https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15068 Muscle synergy structure and gait patterns in children with spastic cerebral palsy.] Developmental Medicine & Child Neurology. 2022 Apr;64(4):462-8.</ref>  In neuroscience it has been proposed that muscle synergies are a mechanism for neural control of movement.<ref>Safavynia S, Torres-Oviedo G, Ting L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143193/ Muscle synergies: implications for clinical evaluation and rehabilitation of movement]. Topics in spinal cord injury rehabilitation. 2011;17(1):16-24.</ref>


The multi-segmented structure of the body provides the basis for producing the varied movement patterns seen in human actions. To simplify control of the many degrees of freedom inherent in a multi-segmented body, spontaneous infant movements are constrained and organised into synergies.
The multi-segmented structure of the body provides the basis for producing the varied movement patterns seen in human actions. To simplify control of the many degrees of freedom inherent in a multi-segmented body, spontaneous infant movements are constrained and organised into synergies.
* ''Lower limb synergy pattern'' includes intralimb coupling of:
** Hip flexion, knee flexion and dorsiflexion
** Hip extension and knee extension


* Lower limb synergy pattern includes intralimb coupling of
* ''Upper limb synergy pattern'' includes a combination of:
** hip flexion, knee flexion and dorsiflexion
** Shoulder and elbow extension with extension of the fingers and wrist
** hip extension and knee extension
** Flexion of the elbow with finger flexion<span class="reference" id="cite_ref-:1_3-0"></span><ref>Versfeld, P. Newborn Infant Course. Plus. 2022</ref>
== General and Fidgety movements ==
Whole body movements, called general movements or GMs,  are complex and involve the entire body, notably the arm, leg, neck, and trunk in variable sequences.<ref name=":0" />


GMs continue to be characterised by writhing movements that involve the head, trunk and extremities in the 1-2 month period. They wax and wane, varying in intensity and speed and range of motion. Rotations around the limb axes and slight changes in the direction of movement create the impression of fluency and elegance. GMs have a gradual onset and a gradual end. However, towards the end of this period, fidgety movements (FMs) are increasingly present. 


FMs are small movements of moderate speed with variable acceleration of the neck, trunk, and limbs in all directions. They may appear as early as six weeks after term, but usually occur from around 9 weeks until 16–20 weeks, occasionally even a few weeks longer. They fade out when antigravity and intentional movements start to dominate.


* Upper limb synergy pattern includes a combination of
The presence and character of FMs are good indicators of the integrity of the infant's nervous system.<ref>Einspieler C, Marschik PB, Prechtl HF. [https://www.researchgate.net/publication/247399672_Human_Motor_Behavior_Prenatal_Origin_and_Early_Postnatal_Development Human motor behavior: Prenatal origin and early postnatal development]. Zeitschrift für Psychologie/Journal of Psychology. 2008;216(3):147.</ref>
** shoulder and elbow extension with extension of the fingers and wrist;
** flexion of the elbow with finger flexion.<span class="reference" id="cite_ref-:1_3-0"></span>
 
These whole body movements, called general movements or GMs,  are complex and involve the entire body, notably arm, leg, neck, and trunk movements in  variable sequences.
 
Over the first few months as the infant explores different ways of interacting with the environment and as the frontal motor areas become more active, the strong intralimb coupling lessens as movement are adapted to allow for effective interaction with the environment. <ref name=":0" />
 
== Head Posture ==
 
* Head turned to one side In supine the newborn's head is mostly rotated to one side, often with a preference for a particular side, usually to the right.<span class="reference" id="cite_ref-4"></span> The reason for this tendency is unclear.<ref>Rönnqvist L, Hopkins B. (1998) [https://www.jstor.org/stable/1132066 Head position preference in the human newborn: a new look]. Child Dev. 69(1):13-23</ref>
* A prominent feature of head rotation in the first two months is the tendency for rotation to be coupled with neck extension and lateral flexion to the opposite side, which is a reflection of the balance in activity between the sternocleidomastoid (SCM) muscles and deep neck flexor muscle activity.<span class="reference" id="cite_ref-:2_5-0"></span><ref>Bly L, Ariz TN. Motor skills acquisition in the first year, an illustrated guide to normal development.</ref>
* Over the first few weeks the infant learns to turn the head to the midline, and can sustain the position briefly, especially when supported by visual attention to an interesting person, object or event.<span class="reference" id="cite_ref-:8_1-2"></span>
* Typically the head is held in the mid-position for brief periods of time when the infant is actively moving the limbs or is distressed.<span class="reference" id="cite_ref-6"></span><ref>Cornwell, K. S., Fitzgerald, H. E., & Harris, L. J. (1985). [[On the state‐dependent nature of infant head orientation.]] Infant Mental Health Journal, 6(3), 137-144.</ref>
* Over the next few weeks the infant will develop the the bilateral antigravity neck muscle strength and control needed to counteract the force of gravity (which creates a turning moment acting on the Center of Gravity (COG) of the head) and maintain the head in the midline for longer periods of time.


== Resources ==


== Lower Limb Range of Motion, Posture and Kicking ==
* [[Newborn Perceptual Motor Behaviour]]


* In infants born at term the range of movement (ROM) of the hips and knees is limited by muscle tightness and increased muscle tone (stiffness) in the lower limbs flexor muscles that result from the flexed posture in the restricted space in the uterus in the last weeks of intrauterine life. This is referred to as neonatal hip flexion contracture.
* [[Understanding Newborn Behaviour]]
* During periods of relative quietening of movement
* [[Development Skills Training for the 1-2 month old]]
** the hips are flexed, abducted and laterally rotated and the infant lies with the feet lifted up off the supporting surface (SS)
* [[Motor Development Principles]]
** the knees cannot be fully extended and when passively extended they recoil back to a more flexed position.
* Newborn kicking actions
** characterised by a decrease in the range of hip flexion, along with some extension of the knee
** the ankle remains in dorsiflexion with the toes in flexion. This relative extension of the hip and knee is followed by a return to the more flexed resting position.<span class="reference" id="cite_ref-:1_3-6"></span><ref name=":0" />
 
==== General and fidgety movements ====
General movements continue to be characterised by writhing movements that involve the head, trunk and extremities in the 1-2 month period. Writhing general movements in the healthy full term infant are described as complex and involve the entire body, notably arm, leg, neck, and trunk movements in variable sequence. They wax and they wane varying in intensity and speed, range of motion, and have a gradual onset and a gradual end. However, towards the end of this period fidgety movements (FMs) are increasingly present.
 
Writhing general movements in a healthy full term infant are described as complex and involve the entire body, notably arm, leg, neck, and trunk movements in variable sequences. They wax and wane, varying in intensity, speed, and range of motion, and have a gradual onset and end. Rotations around the limb axes and slight changes in the direction of movement create the impression of fluency and elegance.
 
FMs are small movements of moderate speed with variable acceleration of the neck, trunk, and limbs in all directions. They may appear as early as six weeks after term, but usually occur from around 9 weeks until 16–20 weeks, occasionally even a few weeks longer. They fade out when antigravity and intentional movements start to dominate.


The presence and character of fidgety movements are good indicators of the integrity of the infant's nervous system.<ref>Einspieler C, Marschik PB, Prechtl HF. [https://www.researchgate.net/publication/247399672_Human_Motor_Behavior_Prenatal_Origin_and_Early_Postnatal_Development Human motor behavior: Prenatal origin and early postnatal development]. Zeitschrift für Psychologie/Journal of Psychology. 2008;216(3):147.</ref>
== References ==
<references />
[[Category:Paediatrics]]
[[Category:Course Pages]]
[[Category:Rehabilitation]]
[[Category:Plus Content]]

Latest revision as of 09:43, 17 January 2024

Original Editor - Robin Tacchetti based on the course by Eskay
Top Contributors - Robin Tacchetti and Jess Bell

Introduction[edit | edit source]

One of the most critical periods for developmental growth occurs during early childhood. Development refers to changes in abilities and skills that improve daily functioning. Meaningful changes in development facilitate a highly dependent child to become an independent individual. Development follows general principles that are universal to all human beings:[1]

  • Change: A progressive series of changes occur during development. These changes are both qualitative and quantitative.
  • Continuous Process: Throughout the life of an individual there is continuous development. Each stage of development builds the groundwork for the next stage.
  • General to Specific: Movement patterns begin with general actions progressing to specific. Large muscle movements precede refined muscle movements.
  • Sequential: Development always follows certain sequences and occurs in an orderly manner.
  • Predictable: Common features and traits occur in every stage that have predictable, orderly patterns.
  • Heredity and Environment: Development is a product of family, culture and social influences. All of these attributes contribute simultaneously to the individual's development.
  • Maturation: Development relies on learning and maturation. Maturation refers to the biological growth or changes that naturally occur over time. These changes take place in the brain and nervous system, and facilitate development in thinking and motor skills. The brain has to develop or mature enough to allow for the next skills in the sequence to develop.
  • Individual Rates of Growth: Development follows usual sequences and patterns, but each individual will develop at their own rate.
  • Specific Directions:
  1. Cephalocaudal: Infants develop by first controlling their head before being able to control their arms and legs. Development takes place in a downward direction with the arms preceding the legs.
  2. Proximodistal: Infants learn to control the centre of their body before the periphery; the head and trunk before the arms and legs.[1]

Flexed Posture[edit | edit source]

In infants born at term, range of motion (ROM) of the hips and knees is limited by muscle tightness and increased muscle tone (stiffness) in the lower limb flexor muscles. This flexed posture occurs because there is restricted space in the uterus in the last weeks of intrauterine life. This position is referred to as neonatal hip flexion contracture.[2]

  • During periods of relative quietening of movement:
    • The hips are flexed, abducted and laterally rotated and the infant lies with their feet lifted up off the supporting surface
    • The knees cannot be fully extended and when passively extended they recoil back to a more flexed position
  • Newborn kicking actions:
    • Characterised by a decrease in the range of hip flexion, along with some extension of the knee
    • The ankle remains in dorsiflexion with the toes in flexion. This relative extension of the hip and knee is followed by a return to the more flexed resting position[2]

Muscle Synergy[edit | edit source]

Muscle synergies refer to consistent muscle coordination patterns that accurately generate a specific motor action.[3] In neuroscience it has been proposed that muscle synergies are a mechanism for neural control of movement.[4]

The multi-segmented structure of the body provides the basis for producing the varied movement patterns seen in human actions. To simplify control of the many degrees of freedom inherent in a multi-segmented body, spontaneous infant movements are constrained and organised into synergies.

  • Lower limb synergy pattern includes intralimb coupling of:
    • Hip flexion, knee flexion and dorsiflexion
    • Hip extension and knee extension
  • Upper limb synergy pattern includes a combination of:
    • Shoulder and elbow extension with extension of the fingers and wrist
    • Flexion of the elbow with finger flexion[5]

General and Fidgety movements[edit | edit source]

Whole body movements, called general movements or GMs,  are complex and involve the entire body, notably the arm, leg, neck, and trunk in variable sequences.[2]

GMs continue to be characterised by writhing movements that involve the head, trunk and extremities in the 1-2 month period. They wax and wane, varying in intensity and speed and range of motion. Rotations around the limb axes and slight changes in the direction of movement create the impression of fluency and elegance. GMs have a gradual onset and a gradual end. However, towards the end of this period, fidgety movements (FMs) are increasingly present.

FMs are small movements of moderate speed with variable acceleration of the neck, trunk, and limbs in all directions. They may appear as early as six weeks after term, but usually occur from around 9 weeks until 16–20 weeks, occasionally even a few weeks longer. They fade out when antigravity and intentional movements start to dominate.

The presence and character of FMs are good indicators of the integrity of the infant's nervous system.[6]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 Singh R, Bisht N, Parveen H. Principles, milestones and interventions for early years of human growth and development: an insight. Int J Curr Microbiol Appl Sci. 2019;8(6):181-90.
  2. ↑ 2.0 2.1 2.2 Von Hofsten C, Rosander K. The development of sensorimotor intelligence in infants. Advances in child development and behavior. 2018 Jan 1;55:73-106.
  3. ↑ Goudriaan M, Papageorgiou E, Shuman BR, Steele KM, Dominici N, Van Campenhout A, Ortibus E, Molenaers G, Desloovere K. Muscle synergy structure and gait patterns in children with spastic cerebral palsy. Developmental Medicine & Child Neurology. 2022 Apr;64(4):462-8.
  4. ↑ Safavynia S, Torres-Oviedo G, Ting L. Muscle synergies: implications for clinical evaluation and rehabilitation of movement. Topics in spinal cord injury rehabilitation. 2011;17(1):16-24.
  5. ↑ Versfeld, P. Newborn Infant Course. Plus. 2022
  6. ↑ Einspieler C, Marschik PB, Prechtl HF. Human motor behavior: Prenatal origin and early postnatal development. Zeitschrift für Psychologie/Journal of Psychology. 2008;216(3):147.
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