Learning To Stand - Development and Training: Difference between revisions
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Repeated steps can be elicited if the infant is moved forwards. This postnatal stepping response can be elicited right after birth, but soon diminishes and disappears by about 2-3 months of age.<ref>Borvendeg K, de Groot L. [https://pubmed.ncbi.nlm.nih.gov/11071141/ The stepping response in early infancy]. Neuropediatrics. 2000 Sep;31(04):180-5.</ref> | Repeated steps can be elicited if the infant is moved forwards. This postnatal stepping response can be elicited right after birth, but soon diminishes and disappears by about 2-3 months of age.<ref>Borvendeg K, de Groot L. [https://pubmed.ncbi.nlm.nih.gov/11071141/ The stepping response in early infancy]. Neuropediatrics. 2000 Sep;31(04):180-5.</ref> | ||
[[File:Infantstanding.jpg|thumb| | [[File:Infantstanding.jpg|thumb|254x254px|alt=|none]] | ||
=== Learning to support the bodyweight on the lower limbs keeping the trunk erect. === | === Learning to support the bodyweight on the lower limbs keeping the trunk erect. === | ||
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With practice and as the lower limb extensor muscle get stronger, the infant supports more of the body weight when supported by a carer.<ref name=":2">Kornafel T, Paremski AC, Prosser LA. [https://onlinelibrary.wiley.com/doi/abs/10.1111/desc.13279 Unweighting infants reveals hidden motor skills]. Developmental Science. 2022 May:e13279.</ref> | With practice and as the lower limb extensor muscle get stronger, the infant supports more of the body weight when supported by a carer.<ref name=":2">Kornafel T, Paremski AC, Prosser LA. [https://onlinelibrary.wiley.com/doi/abs/10.1111/desc.13279 Unweighting infants reveals hidden motor skills]. Developmental Science. 2022 May:e13279.</ref> | ||
[[File:Babystanding.png|none|thumb| | [[File:Babystanding.png|none|thumb|323x323px|Standing with carer support around the chest|alt=]] | ||
By 5-6 months they are able to fully support the weight of the head and trunk. The stand with the hips in extension and in line with the shoulders. Infants have also learned to stand holding onto a carer’s hands. | By 5-6 months they are able to fully support the weight of the head and trunk. The stand with the hips in extension and in line with the shoulders. Infants have also learned to stand holding onto a carer’s hands. | ||
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=== Pull-to-stand === | === Pull-to-stand === | ||
From 8-10 months infants start to pull themselves up into standing with hand support, initially by pulling with the upper limbs and extending the lower limbs. With practice they learn to rise to standing through half-kneeling. <ref>Atun‐Einy O, Berger SE, Scher A. [https://onlinelibrary.wiley.com/doi/10.1002/dev.20593 Pulling to stand: Common trajectories and individual differences in development]. Developmental psychobiology. 2012 Mar;54(2):187-98.</ref> | From 8-10 months infants start to pull themselves up into standing with hand support, initially by pulling with the upper limbs and extending the lower limbs. With practice they learn to rise to standing through half-kneeling. <ref>Atun‐Einy O, Berger SE, Scher A. [https://onlinelibrary.wiley.com/doi/10.1002/dev.20593 Pulling to stand: Common trajectories and individual differences in development]. Developmental psychobiology. 2012 Mar;54(2):187-98.</ref> | ||
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=== Standing with hand-support, learning to balance and reaching === | === Standing with hand-support, learning to balance and reaching === | ||
Once in standing infants will shift their weight from side to side and start to figure out how to balance when lifting one hand to reach for a toy. | Once in standing infants will shift their weight from side to side and start to figure out how to balance when lifting one hand to reach for a toy. | ||
They learn to lift one hand and reach to the side, initially for toys and other interesting objects within easy reach, then to toys that are just out of reach. They also learn to reach upwards and backwards. | They learn to lift one hand and reach to the side, initially for toys and other interesting objects within easy reach, then to toys that are just out of reach. They also learn to reach upwards and backwards. | ||
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== Learning to balance in standing with hand support == | == Learning to balance in standing with hand support == | ||
Once infants have learned to pull themselves into standing with support they spend time exploring the best way to maintain balance when reaching for a toy or turning to look in different directions. | Once infants have learned to pull themselves into standing with support they spend time exploring the best way to maintain balance when reaching for a toy or turning to look in different directions. | ||
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The cross-over pattern is the more stable pattern and with practice the infant starts to use this pattern consistently when reaching or looking in different directions. | The cross-over pattern is the more stable pattern and with practice the infant starts to use this pattern consistently when reaching or looking in different directions. | ||
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With repeated practice infants learns to make small steps sideways to move the BOS vertically below the COM . | With repeated practice infants learns to make small steps sideways to move the BOS vertically below the COM . | ||
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=== Reaching down === | === Reaching down === | ||
Infants also learn to reach down to grasp toys. | Infants also learn to reach down to grasp toys. | ||
Often they start by bending at the hips and tipping the trunk forwards. With practice they learn to flex the hips and knees as they lean forwards to reach for a toy on the floor. | Often they start by bending at the hips and tipping the trunk forwards. With practice they learn to flex the hips and knees as they lean forwards to reach for a toy on the floor. | ||
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=== Cruising === | === Cruising === | ||
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Infants learn to coordinate their limb movements to allow them to traverse across gaps of ever increasing size. | Infants learn to coordinate their limb movements to allow them to traverse across gaps of ever increasing size. | ||
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This antiphase movement of upper and lower limbs is the same as seen in crawling. | This antiphase movement of upper and lower limbs is the same as seen in crawling. | ||
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=== Learning to sit down === | === Learning to sit down === | ||
Infants’ first experience of sitting down from standing happens when they lose their balance and fall down. With experience they learn sit down by moving their buttocks backwards and tipping the trunk forwards so that they land in a sitting position. | Infants’ first experience of sitting down from standing happens when they lose their balance and fall down. With experience they learn sit down by moving their buttocks backwards and tipping the trunk forwards so that they land in a sitting position. | ||
[[File:Pamv211.png|none|thumb| | [[File:Pamv211.png|none|thumb|600x600px|alt=]] | ||
With practice infants learn to flex their hips and knees and tip the trunk forwards and lower themselves to a squat position and then sit from there. | With practice infants learn to flex their hips and knees and tip the trunk forwards and lower themselves to a squat position and then sit from there. | ||
[[File:Pamv213.png|none|thumb|600x600px]] | [[File:Pamv213.png|none|thumb|600x600px]] | ||
Revision as of 18:29, 6 January 2023
How infants learn to stand with support, cruise and walk[edit | edit source]
As is the case with learning any new skill it takes hours of practice with repetition and exploration of the different ways to achieve a desired outcome. It requires persistence, repeated experience of success as well as repeated failures.[1] [2]
Learning to stand and cruise with support, and then to stand without support and take the first steps can be divided into 3 phases:
1: Learning to support the body weight on the lower limbs keeping the trunk erect with carer support.
2 Standing and stepping with hand support
3 Standing independently and early walking
Motor Assessment of the Developing Infant (AIMS)[edit | edit source]
The AIMS provides a useful guide to the sequence of abilities commonly seen in typically developing infants as well as the age range at which 50 and 90% of infants acquire these abilities.[3]
The AIMS was standardized on infants living in Canada but has subsequently been studied in numerous samples around the world.[4][5][6][7]
Interestingly although there are differences in the age at which infants in different studies achieved the different items in each subscale, the sequence of the items remained the same.
However, for the purpose of describing the development of standing, the sequence of the acquiring the different items is more useful that the age of achievement[1].
Phase 1: Learning to support body weight on the lower limbs[edit | edit source]
Newborn stepping[edit | edit source]
When new born infants are supported around the upper chest in an upright position with the feet touching a support surface they will take variable amounts weight on the lower limbs.
Repeated steps can be elicited if the infant is moved forwards. This postnatal stepping response can be elicited right after birth, but soon diminishes and disappears by about 2-3 months of age.[8]
Learning to support the bodyweight on the lower limbs keeping the trunk erect.[edit | edit source]
In this phase of learning to stand, when the infant is held upright supported around the chest by a carer they learn to actively extend the trunk, hips and knees to support the body weight.
Initially at 1-2 months (Piper 2022) the infant stands with the hips is some flexion with the trunk tilted forwards. They are not yet able to support their weight fully.
With practice and as the lower limb extensor muscle get stronger, the infant supports more of the body weight when supported by a carer.[9]
By 5-6 months they are able to fully support the weight of the head and trunk. The stand with the hips in extension and in line with the shoulders. Infants have also learned to stand holding onto a carer’s hands.
At this stage the infant takes great pleasure in standing, and will often flex and extend the knees in a bouncing action. These repeated movements play a role in training the movement brain to use sensory input from the muscles and joints to adjust the amount of muscle force needed maintain extension under varying circumstances. [9]
Phase 2 Standing and cruising with hand support[edit | edit source]
Pull-to-stand[edit | edit source]
From 8-10 months infants start to pull themselves up into standing with hand support, initially by pulling with the upper limbs and extending the lower limbs. With practice they learn to rise to standing through half-kneeling. [10]
Standing with hand-support, learning to balance and reaching[edit | edit source]
Once in standing infants will shift their weight from side to side and start to figure out how to balance when lifting one hand to reach for a toy.
They learn to lift one hand and reach to the side, initially for toys and other interesting objects within easy reach, then to toys that are just out of reach. They also learn to reach upwards and backwards.
Learning to balance in standing with hand support[edit | edit source]
Once infants have learned to pull themselves into standing with support they spend time exploring the best way to maintain balance when reaching for a toy or turning to look in different directions.
This exploration of weight shift and trunk alignment to maintain balance is facilitated by the infant’s desire to lift one hand and reach for toys.
Initially they experiment with different ways of distributing their weight when lifting one hand, with two patterns of weight distribution being seen, namely an ipsilateral and a contralateral pattern.
The ipsilateral pattern
When one arm is lifted weight is shifted onto the contralateral hand and lower limb. This is an unstable pattern as the side-to-side base of support is narrow and infants easily fall sideways if they shift their weight too close to the lateral edge of the base of support (BOS).
The cross-over (contralateral) pattern
Infants who actively explore redistributing their weight in different ways soon discover that the most stable pattern when one hand is lifted, is to redistribute the weight onto the ipsilateral lower limb and contralateral hand. I call this the cross-over pattern.
This pattern of weight distribution keeps the line of gravity (LOG) close to the center of the BOS
The same pattern is seen when the infant turns to look to one side.
The cross-over pattern is the more stable pattern and with practice the infant starts to use this pattern consistently when reaching or looking in different directions.
Vertical alignment of trunk and lower limbs[edit | edit source]
Along with learning to use a cross-over pattern of weight distribution infants also need to learn to keep the trunk and lower limbs vertically aligned.
Reaching far to one side is sometimes accomplished by moving the trunk to the same side.
This means that the trunk is not vertically aligned with the lower limbs. In other words to keep the BOS vertically aligned below the COM so that the LOG falls well within the BOS..
With repeated practice infants learns to make small steps sideways to move the BOS vertically below the COM .
Reaching down[edit | edit source]
Infants also learn to reach down to grasp toys.
Often they start by bending at the hips and tipping the trunk forwards. With practice they learn to flex the hips and knees as they lean forwards to reach for a toy on the floor.
Cruising[edit | edit source]
Cruising differs from stepping in that the infant takes a series of steps with a defined stance and swing phase for each lower extremity.
Repositioning of the hand on the support surface is synchronized with the lower limb movements in an antiphase manner. With experience this antiphase coordination improves and speed increases.
Infants learn to coordinate their limb movements to allow them to traverse across gaps of ever increasing size.
This antiphase movement of upper and lower limbs is the same as seen in crawling.
However recent research by Ori Osmy and Karen Adolph from New York University has shown that the emergence of well coordinated antiphase cruising is not influenced by crawling experience and competence. It is however influenced by the infant’s experience of cruising and the structure of the environment such as height and type of support surface and gaps between support surfaces.[11]
Learning to sit down[edit | edit source]
Infants’ first experience of sitting down from standing happens when they lose their balance and fall down. With experience they learn sit down by moving their buttocks backwards and tipping the trunk forwards so that they land in a sitting position.
With practice infants learn to flex their hips and knees and tip the trunk forwards and lower themselves to a squat position and then sit from there.
Phase 3: Learning to let go and stand independently and take first steps[edit | edit source]
The next skill infants acquire from about 10.5-13 months (Piper) is ls to let go of the support surface and stand independently without support for brief periods.[12]
This is followed by taking a few steps forwards. Steps are quick, short and the base is wide.
Postural sway[edit | edit source]
An important aspect of maintaining balance in sitting and standing is integrating and weighting the sensory information from different sources (touch, proprioception, vestibular and visual) needed for estimating the position of the body as a whole. This integration is reflected in the presence and extent of postural sway.
Carpenter et al's research (2010) suggests that postural sway may be used by the CNS as an exploratory mechanism to ensure that continuous dynamic sensory inputs are provided.
“The postural sway patterns of newly standing infants were compared under two conditions: standing while holding a toy and standing while not holding a toy. Infants exhibited a lower magnitude of postural sway and more complex sway patterns when holding the toy. These changes suggest that infants adapt postural sway in a manner that facilitates visually fixating on and stabilizing the toy in their hand. When simply standing, infants exhibited postural sway patterns that appeared to be more exploratory in nature. Exploratory sway patterns may allow infants to learn the affordances of their new standing posture. These results demonstrate that newly standing infants are capable of task-dependent postural control.”[13]
Squatting and standing up from the floor[edit | edit source]
Infants also learn to squat down and stand up again with controlled flexion and extension of the knees and start to play in squatting.
They learn to stand up from sitting by first getting up.
Once infants can stand independently they start to take small steps forwards. The age of onset of walking is very variable, with typically developing children starting to walk any time from 11-14 months [3]
References[edit | edit source]
- ↑ 1.0 1.1 Adolph KE, Hoch JE, Cole WG. Development (of walking): 15 suggestions. Trends in Cognitive Sciences. 2018 Aug 1;22(8):699-711.
- ↑ Dewolf AH, Sylos Labini F, Ivanenko Y, Lacquaniti F. Development of Locomotor-Related Movements in Early Infancy. Frontiers in Cellular Neuroscience. 2021 Jan 21;14:623759.
- ↑ 3.0 3.1 Piper MC, Darrah J. Motor assessment of the developing infant. WB Saunders Company; 1994.
- ↑ Eliks M, Gajewska E. The Alberta Infant Motor Scale: A tool for the assessment of motor aspects of neurodevelopment in infancy and early childhood. Frontiers in Neurology. 2022;13.
- ↑ Eliks M, Sowińska A, Gajewska E. The Polish Version of the Alberta Infant Motor Scale: Cultural Adaptation and Validation. Frontiers in Neurology. 2022;13.
- ↑ Gontijo AP, de Melo Mambrini JV, Mancini MC. Cross-country validity of the Alberta Infant Motor Scale using a Brazilian sample. Brazilian Journal of Physical Therapy. 2021 Jul 1;25(4):444-9.
- ↑ Gautier C, Alexandre M, Zaczek S, Mostaert A, Legros L. Comparative validity between the Canadian and the Dutch norms of the Alberta Infant Motor Scale in a preterm population. Child: Care, Health and Development. 2022 Mar 16.
- ↑ Borvendeg K, de Groot L. The stepping response in early infancy. Neuropediatrics. 2000 Sep;31(04):180-5.
- ↑ 9.0 9.1 Kornafel T, Paremski AC, Prosser LA. Unweighting infants reveals hidden motor skills. Developmental Science. 2022 May:e13279.
- ↑ Atun‐Einy O, Berger SE, Scher A. Pulling to stand: Common trajectories and individual differences in development. Developmental psychobiology. 2012 Mar;54(2):187-98.
- ↑ Ossmy O, Adolph KE. Real-time assembly of coordination patterns in human infants. Current Biology. 2020 Dec 7;30(23):4553-62.
- ↑ Størvold GV, Aarethun K, Bratberg GH. Age for onset of walking and prewalking strategies. Early human development. 2013 Sep 1;89(9):655-9.
- ↑ Claxton LJ, Melzer DK, Ryu JH, Haddad JM. The control of posture in newly standing infants is task dependent. Journal of experimental child psychology. 2012 Sep 1;113(1):159-65.
