Reading material on improving movement analysis and therapy

Kuura is a 6-month-old and 1-month-old baby with a referral to physiotherapy by a public health nurse. Kuura is the second child in the family with a 3-year-old older sibling. Kuura’s mother was a little concerned about Kuura’s motor development, as the baby seemed to prefer the left side when rolling over. Other than that, the mother had no concerns about the baby’s development. Kuura and their mother come to physiotherapy for the first time.

What we know from the patient history:

Kuura was born as the family’s second child on week 39+5, weighing 3760g and 51cm long. Kuura has developed normally so far and has achieved all the motor milestones according to age. Kuura is still breastfed but is already practising eating cooked carrots, potatoes, and sweet potatoes. Kuura sleeps well and is expected to be active during the time of the scheduled physiotherapy. We can also see from the documentation that the family wants to use gender-neutral terms; therefore, they have also selected a gender-neutral name, Kuura, for the child.

With a limited amount of data available, physiotherapists need to be well prepared and plan the meetings carefully. A soft mattress is selected, with the possibility of observing the baby on a hard surface. The observation is made during spontaneous play if possible. It is important that we select beforehand suitable toys to achieve the goals of observation and participate actively in the interaction. Engaging the caregivers in observation needs space. Things to pay attention are also parent-child interaction and handling the baby. We make a list of the milestones we expect to see and look for symmetry/asymmetry, muscle tone and interaction through play.

Mary D. Sheridan’s book is a good source of information on preparing for motor development observation is From Birth to Five Years, children’s Developmental Progress, 2021, Routledge. By reading the book, you are able to learn the steps of motor evaluation (performance, quality of movement, symmetry, typical and atypical movement, and decision-making). You can also go through the age-related motor milestones that you can assume to detect through observation and examination of the child. At this point, it is also good to refresh your memory on gender-sensitive terms.

At 6 months of age, we start to see weight shifts. We can expect that the child will lie on their back and raise their hands to be lifted. When hands are grasped, the child should be able to lift the head, brace shoulders, and pull to sit. When the child is pulled to supported sitting, the back is straight and the child is able to turn their head from side to side. The child is not yet expected to sit independently. Additionally, it is possible for the child to roll over from supine to prone and from prone to pine, but this typically happens by 7 months. Could also be expected to roll over from supine to prone and from prone to pine, but it is usually achieved by 7 months. On the abdomen, the child should be able to have open palms and the ability to support themselves on extended extremities. When the child is held in a standing position, they take weight on the legs and usually also like to bounce up and down. The child is beginning to show signs of protective reactions and at this phase such as downward parachute and sideward/foreward protective reaction. The child is able to manipulate objects and change them between the hands. (Sheridan, M.D. 2008. From birth to five years).

Red flags mean that the child is not achieving the majority of the milestones, there is a sudden stop of constant progress over weeks, or deprivation of already gained skills. If a red flag is detected during the observation, the caregivers are carefully explained that the baby needs further examination and should be referred to a doctor and checked up within few weeks. Parents are often really worried and it is very important that the situation is explained in detail and that time will show if there is something to be concerned. With a child that has reached motor milestones on time so far, at six months following signs would indicate for a red flag: Child doesn’t roll in either direction. Child is not able to bring hands to the midline and together on supine. Child is having difficulties in bringing hands to mouth. Child only uses either upper extremity while other is fisted when reaching for objects. (Department of Health and Human Services, Centers for disease control and prevention)

Still, it is very important to remember that even though observation and examination constitute a crucial part of screening motor development, it is essential to use also standardized measures to ensure a systematic method to administer and score and record a child’s assessment. This allows the therapists to compare results between the assessments. For example, with preterm infants, motor assessments are done on a regular basis due to the high risk of motor delays. (Piper, M. C, Darrah J, 2022)

Use of different measurement tools are discussed in more detail in E- manual.