Wednesday, April 13, 2011

Ready, Set, Go!

After reading the request for a blog carnival over at Therextras regarding readiness in children, I pondered the topic a bit. What does make a child ready to achieve motor milestones? Many parents and therapists follow the typical developmental sequence of rolling, sitting, crawling, standing, walking and off they run. The theory is that if you build each skill upon the previous skill the child will move along the progression. The problem is the theory doesn't hold true. There are many more factors besides muscle development and control that play a role in achieving motor milestones.

Motivation: In order to move on to the next skill, a child needs to be motivated. This is clearly seen in typical development. For example, a 6 month old baby usually needs assistance to get into a sitting position. The baby is motivated to stay in the supported sitting position and works hard at maintaining an upright posture. The degrees of freedom available to the arms and hands increases significantly compared to the prone or supine position.

Socialization: A child may choose to attempt to try a new skill in order to experience a new social perspective. Sitting and standing change the eye contact of a child compared to supine or prone. A recent study indicated that independently walking infants spent significantly more time interacting with toys and mothers, made more vocalizations and directed gestures than age matched, crawling peers in a baby walker (1).

Novelty: Children have short attention spans. A change in position can result in a renewed attention span. The forces of gravity on the hands, postural muscles and legs change significantly based on different positions. Toys can take on new properties when the hands are freed up to play with them.

For example, I once worked with a 5 year old girl with quadriplegia. She required adult assistance to propel her manual wheelchair. She only tolerated a standing frame for short periods of time. We decided to try a mobile stander. Once in the mobile stander, the girl could actually propel herself around the room in standing. She not only tolerated standing now, she loved it. Her motivational level was increased. Her socialization increased once she could achieve level eye contact with her peers. The novelty of the mobile stander also added to her increased motivation.

In addition, I worked with a 7 year old boy with athetosis. He was unable to sit unsupported for longer than a few seconds but he could walk throughout the entire school without an assistive device. This boy's motivational drive to achieve independent walking was amazing.

Or how about a 5 year old boy who had the motivational drive to negotiate playground equipment to socialize with his peers but he was unable to walk long distances without his rolling walker. This boy taught me never to assume that a skill can not be achieved. He was able to climb ladders, walk across moving bridges and go down slides!

Therefore, the question arises should you wait to try the next motor skill in the developmental progression until the one before it has been mastered? Absolutely not! By using adaptive equipment or external support, children can benefit from the socialization and novelty factor of new skills. If the child recognizes these benefits, the internal motivation to continue to practice will help to drive the achievement of the new motor skill.

1. Melissa W. Clearfield Learning to walk changes infants’ social interactions. Infant Behavior and Development Volume 34, Issue 1, February 2011, Pages 15-25


TherExtras said...

Excellent, Margaret!

I am a huge believer in using novelty to prompt children towards change.

Breaking away from the chains of rigidly following a developmental progression has freed me and many-a child. Barbara

Rose-Marie said...

This is a most encouraging read--thank you!! I just love your example stories. What proud kids and families you get to work with!

Every few years, a clear verbal word will slip out of my non-verbal daughter's mouth if her motivation is extremely high, as though the emotion allows the small motor movement to bypass her motor planning. Do you think this can happen with coordinating gross motor movements the same way? Assuming, of course, that strength and balance are already in place...emotion bypassing the overall motor planning piece?

Your Therapy Source Inc said...

I have had experience with a few children who are able to speak full, clear words on rare occasions based on motivational levels and what I observed to be respiration as well. The children that I encountered had just the right timing of respiration, motor movements and motivation. I don't think that emotion bypasses the motor planning piece but more that the emotion/ motivation kick starts the motor plan into action.

I have to say these moments of clarity whether it be speech or motor actions, offer reassurance that skills are being absorbed and learned when perhaps we don't see it on a daily basis as therapists, parents or teachers.

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