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NEURODEVELOPMENTAL TREATMENT

R K Senthil Kumar - Occupational Therapist

R K Senthil Kumar - Occupational Therapist

  Koramangala, Bengaluru     Feb 24, 2017

   4 min     

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The supine position allows the child’s head to be supported so that they can see and watch nearby activities or their own arms and legs. The child has to move against gravity, which is an important beginning for learning muscle coordination.

As the child moves their arms and legs, their body is shifted from side to side, which helps develop the balance responses of the body. The movement skills learned in the supine position help to lay the foundation for the development of more advanced motor skills.

The child optimally positioned with their head in midline and their chin slightly ticked. Their shoulders should be down and their arms should be forward with their hands towards the middle of the body. The child’s body should be straight, with their hips and knees bent.

Be careful that the child’s arms and legs are not positioned away from the middle of the body, lying flat against the ground, [frogged position] – this is a tendency for children who tend to have hypotonic muscles.


Prone Lying

Prone is an important developmental position. Head control develops as the head is lifted and turned. When the child begins to push up on their arms and lean on their elbows and hands, the child is beginning to develop the muscles of their shoulders and arms. The more a child lifts their head and the higher the child pushes up with their arms, the more the muscles of their back are developed, [spinal extension]. The child also shifts body weight towards the hips, beginning the development of their hip muscles.

As the child learns to shift weight to lean on one arm whilst reaching with the other, the child learns to isolate motor control of their arms and hands. These movement skills provide a foundation for the development of more advanced motor skills.

Sitting

Sitting is important for the child because, when upright, they can develop head control and see their surroundings. In sitting, a child learns to hold and balance their body upright against gravity and they begin to develop control of their hip muscles.

Initially, a child uses their arms to support their body and this helps to increase arm strength. As the child is able to use their hip, abdominal and back muscles to remain upright, the arms and hands are free to reach and play. As a child reaches outwards for toys, they learn to shift their body weight whilst maintaining balance. They also learn to change position.

When sitting on the floor, the child’s head should be upright, in line with the body and chin tucked. Their body should be upright and straight, with their hips bent to 90 degrees and legs out in front.

Children should NOT BE ALLOWED to ‘W-SIT’ as this does not allow them to develop balancing skills. Prolonged ‘W-sitting’ can affect the ligaments in the hips and knees and can shorten the muscles that pass behind the knees.

“W”- SITTING

Static kneeling

Place the child on knees in front of a stool, which is of chest height. Put some toys and place child's hands on the stool, support at the pelvis.

This position allows good weight bearing at both the hip and knee which acts as a good hip and trunk stability exercise.

Standing

Standing is important in the child’s development and some children need help to achieve this. In standing the child experiences the feeling of weight bearing and they can begin to strengthen / develop leg, hip and body muscles.

Standing position increases the child’s awareness of their environment and, when appropriately supported, allows optimum arm function.

walking

MONTHS
GROSS MOTOR
RED FLAGS



SKILLS



2
chest up in prone
Rolling prior



position, head bobs
to 3 / 12 may



errect if held sitting
indicate




hypertonia.


5
Rolls back to front.
Poor head



Lifts head when
control



pulled to sit .




Sits with pelvic




support Anterior




protection


NEEDS
7
Sits without support .
“W” sitting

OCCUPATIONAL

Supports weight and
and bunny

THERAPY

bounces while
hopping, May

INTERVENTION

standing.
indicate



Feet to mouth
adductor



Lateral protection
spasticity or




hypotonia.


9
Pulls to dtand
Persistance of



Creeps on hands and
a primitive



knees
reflexes may




indicate




neuromotor




disorder








MONTHS
GROSS MOTOR
RED FLAGS




SKILLS




12
Independent steps
Failure to




Posterior
develop




protection
protective





reactions may





indicate





neuromotor





disorder



18
Push / pulls large
Hand dominance




objects
prior to 18

NEEDS


Throws ball
months may




OCCUPATIONAL


while standing
indicate contra




THERAPY


Seats self in
lateral weakness




INTERVENTION


small chair








24
Jumps in place
Inability to walk







Kicks bsll
up and down




Walks down
stairs may be the




stairs with rail,
result of lack of




marking time
opportunity




Throws overhand





HOME PROGRAMME – R.K.SENTHIL KUMAR, IN-CHARGE OCCUPATIONAL THERAPY, ST.JOHN’S MEDICAL COLEGE & HOSPITAL


Tags:  Child Care, neurology, locomotor system, Exercise, hypotonic muscles,

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