Dana loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1). Dana’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies. As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins. However, her teacher shares concern that Dana struggles to keep up with the movement pace of the classroom. How can you compare Dana’s classroom mobility to that of her peers? Is there a test with norms that you can use?
TFTS-N Quick Facts:
- 5-14 years
- Stand-alone test for children in school environments
- Walking at a natural pace
- Timing begins at “go,” not when movement is initiated
- Tape 3m apart on floor
- Face validity: activity of transitioning to/from floor and walking short distance.
The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting. The sitting position is tailor (criss-cross). Continue reading “How to Use the Timed Floor to Stand-Natural Test (TFTS-N)”
“Jack has had tummy time every day since he was three days old. At first he didn’t like being on his stomach, but now he is happy to play a while in this position. He is interested in lifting his head to get his mouth on his hand. It’s like a game to him.”
In tummy time, we want to see a progression of extension through the baby’s back over the first several months. I’m always in awe and a little surprised at the slow but steady day-by-day progression, especially in the first month. In the first days of tummy time, the weight is on the baby’s face and it is not the most comfortable looking position. Nevertheless, exciting changes are on the way!
Continue reading “1 Month: Starting to Lift the Head”
Fin is 3 1/2 months old and is learning to hold a toy between his hands. He can tuck his chin and gaze at the toy in hands for a moment. Why is chin tuck considered an important early developmental milestone?
The three-month-old is discovering postural control in midline. One of the first stabilizing motions is the chin tuck. The baby is able to stabilize the head and trunk in midline and begin to touch his hands together over the chest. He will begin to spend moments looking down toward the hands as they are together. Continue reading “3 Months: Chin Tuck”
Walking from class to the school library, Josh falls to the back of the line. Shortly thereafter, a gap forms between Josh and the rest of his class. He is last to arrive and gets the half-functioning computer that everyone else avoids. As his PT, you are there to observe, problem-solve and treat. The computer lab is a half-minute walk from class. His teacher comments “Is that really as fast as Josh can walk? Has it always been that way?”. Do you have an answer for this question?
30sWT Quick Facts:
- Age 5-17
- natural environment
- walking at natural pace
Josh’s slow walking speed was a major concern at the begining of the school year. At that time you did the thirty-second walk test (30sWT) and the result was clear; he was below the 5th percentile for boys his age and off the low-end of the chart. Although you are having this conversation right now, you think he has improved because he has propulsion and a more efficient gait. Continue reading “How to Use the 30-Second Walk Test (30sWT)”
“Yesterday was a big day because Zahra sat all by herself! She is so happy! Of course, I had to put her in this position first. She can’t take her hands off her feet because she falls backwards. I keep her safe by putting soft pillows and blankets all around her and sitting with her while she plays.”
Zahra is five-months old and has attained the developmental milestone of sitting independently. Her parents are proud and it is easy to see that Zahara is proud too. What are the building blocks for independent sitting? Continue reading “5 Months: Sitting”
“When Phoebe’s little legs are tucked under her body, I see how she was able to fit into the tiny space of the womb. At first I was concerned because I didn’t know why her legs were positioned like that.”
Babies born at gestational term have a tightness to their bodies called physiological flexion. Space was limited in the final trimester and the baby assumed the most compact position with arms and legs held close to her core. Physiological flexion provides some passive stability for the newborn baby to use for function. Practice will provide an opportunity to decrease muscle tightness through active movement. In turn, active movement provides sensory input and postural control. Development happens gradually, month by month with one skill building upon another. The posts in the milestones category describe the maturation of babies in the first year of life as they begin tightly flexed and learn to roll, sit, cruise and stand.
Continue reading “Why Do the Legs of Newborn Babies Look Bowed?”
Elise is constantly falling during her school day. She often has skinned knees and bruises. Although she is 10, she walks down stairs one step at a time. As Elise’s physical therapist, what will you use to measure her functional balance skills? How will you document her progress?
Balance is defined as the ability to keep the center of mass over the base of support.
Postural control is the act of maintaining, achieving or restoring a state of balance during an activity.
Link to Pediatric Balance Scale Score Sheet with minimal detectable change (MDC) & minimally clinically important difference (MCID) values.
Pediatric physical therapists informally evaluate balance and postural control in every movement. Multiple body systems contribute to balance, and this makes measurement of functional balance somewhat challenging.
Continue reading “How to Use the Pediatric Balance Scale”
“My 6-month old daughter rocks on her belly and moves her arms all around. It looks like she is swimming on land! What is going on while she is playing like that?”
This swimming motion, common during the development of 5-6 month olds, is also known as pivot prone. The first time you might see something like this would be during a Landau reaction. The Landau reaction emerges at approximately 3 months as a reflex/postural reaction, allowing the baby to extend against gravity while held at the stomach. However, by 5-6 months of age, the baby has developed the strength and flexibility to play with it in a variety of ways while on the floor. These new sensations and movement keep interest in the activity. You might see a few seconds of swimming motion followed by a push into the floor or rocking back and forth. In these actions, the baby is strengthening their postural control system to balance flexion and extension. The difference in this stage is that the gluteals are becoming active and the hips are fully elongated. With practice the thighs begin to come off the ground through the action of the gluteals. During pivot prone, there is eccentric action of the abdominals as the baby extends so there is also controlled motion through the range.
During pivot prone play, the baby is strengthening and discovering:
Continue reading “6 Months: Pivot Prone”
Q: What happens when a baby brings hands to knees and then weight shifts or looks to the side?
A: Her whole body rolls to the side and she learns to control it and use it for function.
Around 5-6 months, this little one has learned to initiate some big movements like pushing up onto hands while on her stomach and grabbing knees and feet while on her back. She is busy reaching and looking around. Combining foundation skills such as hands to knees and weight shifts, larger movements begin to evolve, like rolling from back to side (otherwise known as supine to sidelying). At this stage babies may enjoy playing while balancing in sidelying. They may also enjoy the sensation of rolling.
What is happening as this baby rolls from supine to sidelying?
Continue reading “5 Months: Rolling to Side”
Life is so exciting for the six month old; once she learns to roll to the side, it is fun to play in this position. Beyond fun for the little one, what special things are happening with development at this stage? After all, play is child’s work.
- Mastering the balance of flexion and extension in the trunk: she is able to play in sidelying without falling forward or backward.
- Increasing shoulder girdle control and stability- allowing propping on one arm to play.
- Emergence/increasing lower extremity dissociation: one foot can prop to meet the ground and stabilize in this position. To do this, one leg must be flexed, the other extended while weight is increasingly shifted to the hip that contacts the floor.
- Foot weight-bearing: bringing the foot to meet the ground and getting some weight on to different parts of the foot in order to prepare for standing.
- Lateral flexibility and of the trunk/rib cage.
- Lateral head righting against gravity.
From this position your little one can grab toys to mouth, providing a whole new level of independence for exploration! All of these movements build the foundation for transitions that come in later months like progressing to side sitting, getting up on all fours and pulling to stand.