R K Senthil Kumar - Occupational Therapist
Koramangala, Bengaluru Feb 24, 2017
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 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 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.
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 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.
|MONTHS||GROSS MOTOR||RED FLAGS|
|2||chest up in prone||Rolling prior|
|position, head bobs||to 3 / 12 may|
|errect if held sitting||indicate|
|5||Rolls back to front.||Poor head|
|Lifts head when||control|
|pulled to sit .|
|Sits with pelvic|
|7||Sits without support .||“W” sitting||OCCUPATIONAL|
|Supports weight and||and bunny||THERAPY|
|bounces while||hopping, May||INTERVENTION|
|Feet to mouth||adductor|
|Lateral protection||spasticity or|
|9||Pulls to dtand||Persistance of|
|Creeps on hands and||a primitive|
|MONTHS||GROSS MOTOR||RED FLAGS|
|12||Independent steps||Failure to|
|18||Push / pulls large||Hand dominance|
|objects||prior to 18||NEEDS|
|Throws ball||months may|
|while standing||indicate contra|
|Seats self in||lateral weakness|
|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|
HOME PROGRAMME – R.K.SENTHIL KUMAR, IN-CHARGE OCCUPATIONAL THERAPY, ST.JOHN’S MEDICAL COLEGE & HOSPITAL