Advanced Gross Motor Skills in Children

Intro

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gallop/skio

Introduction

The child begins pulling himself to standing in his crib at about this time (7 to 8 months). At first, this is accomplished by using the newly developed strength of the upper extremities, while the lower extremities remain essentially passive. Once standing, the child will frequently hold onto the crib rails for support while he bounces and experiments with this newly discovered standing ability. During his earliest attempts at supported standing in the crib, he finds that he is unable to get down. Lowering himself slowly to the mattress requires strong eccentric control of his hips and knees, something that he has not developed. Frustrated and tired of standing, he may simply let go of the crib rails and drop to sitting, thanks to gravity, or he may begin to cry, signaling to his parent his need for help. A parent will come and either take the child from the crib or put him down inparagraph about transitioning to walking

7 Months

At 7 months, the child can only stand and walk with their hands held. The necessity for external support is due to their underdeveloped balance responses and poor anterior-posterior weighbearing alignment.. Gait at this age is marked by a wide base of support with moderate abduction with hip external rotation and pronated feet. The amount of pronation correlates to the amount of abduction and external rotation of the hips. Children at this state will walk with their hip and knees flexed.

Pull-to-Stand

Around 10 months old, the child is able to pull themselves up to standing using a low table or sofa. From this position, the child is able to get down to the floor with control. The process of pull to stand moves through tall-kneeling and half-kneeling.

• Tall-kneeling:
  • weight on both knees
  • wide base of support
  • use of upper extremities to pull up
• Half-kneeling:
  • shift weight to one side
  • elongated trunk on weight shifted side
  • unweighted leg moves forward to place foot flat on floor
  • use of hip and knee extensors to facilitate moving against gravity

Moving back to the floor uses the same half-kneeling and tall-kneeling positions. Initially these movements the child will let go and quickly drop to the floor. With time and practice, these movements will become controlled and accurate

Cruising

Once the child is able to pull-to-stand, they will play for long periods of time squatting and standing moving back and forth between furniture and floor. The new skill allows the child to squat to play and to pick up toys from the floor and place on the sofa. Squatting becomes both a posture in itself and a transition movement between postures. As the child moves from squat-stand-squat, co-contraction of the ankle musculature occurs enhancing stability.

Around 10 months old, children will begin stepping sideways holding furniture for support. This supported lateral movement is referred to as cruising, With this newfound mobility, the child is able to work their way along the furniture and eventually able to reach other pieces of furniture in an effort to navigate the room. Cruising gait exhibits less hip and knee flexion and better anterior-posterior alignment. Balance is improved during this time as the child is able to lift one supported hand and rotate their body. They may even take 1-2 steps without support from either upper extremity. Cruising helps the child to strengthen their lower extremity musculature specifically the hip abductors/adductors and ankle evertors/invertors. At 10 months of age, the plantar grasp reflex may still be present although considerably diminished. Complete resolution of the reflex is necessary for independent unsupported walking to develop.The child will eventually stand independently letting go of their upper extremity support from furniture or an adult. When this occurs, trunk stability is maintained by a high guard position of the upper extremities.

Independent Ambulation

Between 10-15 months old, children begin to walk independently with the average age of 12 months.

Initial Gait

• upper extremities in a high guard position
• adducted scapulae
• hip and knees flexed
• abduction and external rotation of the hips
• wide base of support
• pronated feet
• no heel strike

Gait Progression 1

• upper extremities in low guard position
• elbows flexed
• hands just above waist and stabilised against the body
• fingers pointing upwards
• shoulders adducted

Gait Progression 2

• upper extremities in shoulder extension and hang at child's side
• reciprocal arm swing
• increasing hip and knee extension
• decreased hip abduction
• decreased external rotation of the hip
• narrowing of base of support
• neutral pronation/supination of the feet
• heel strike, push off

Gait Parameters

Over the next 2-4 years, gait will continue to improve. Gait parameters such as step and stride length and velocity and cadence will change as they grow and mature.

The measurement from heel strike on one foot to heel strike on the opposite foot is referred to as step length. Stride, on the other hand is measured from heel strike on one lower extremity to heel strike on the same extremity. Stride length is roughly twice the step length. Velocity (distance covered over a specified amount of time) is correlated to the length of one's stride or step. Between the ages of 1-3, a child's velocity increases as their stride and step length increase.

During initial independent walking, the child spends very little time in single limb stance due to lack of strength and stability in their hips. This decreased stance time results in a high cadence (the number of steps per minute). As their strength and balance increase over time, the amount of time in single limb stance increases with subsequent decreased cadence.

As they age, children begin to walk with a fast speed, however it is not truly running unless both feet are off the ground at the same time. True running occurs between 3-4 years old.

Stairs

The ability of a toddler to negotiate stairs has many factors with opportunity being a main one. Some children do not have stairs in the home and therefore may not have the chance to practice this milestone. Those who do have stairs are more likely to ascend stairs at a younger age.

Initially stair climbing takes the form of both feet landing on each step. Alternating feet with stair climbing does not generally occur until the age of 3.

Upper extremity support changes as stair climbing progresses. Initially the child will be dependent on upper extremity support from a handrail or adult. As they progress, they will not need the support of an adult, however they will use the handrail. Eventually, they will no longer need any upper extremity support.

Resources

• Learning to Stand
• Gross Motor Skills