5 Months: Feet to Mouth

Your 5-month-old just learned to lift his feet from the ground and grab them with his hands.  What’s next?  Putting the toes into the mouth, of course!

This is such a sweet phase of development.  Here is a quick review of the amazing things that are happening as your baby pulls her toes to her mouth.

  • Activated abdominal muscles!  You can see activity in the lower abdominals from the wrinkles on this baby’s tummy.  Additionally,  the baby’s pelvis is up off the ground.
  • Developing and strengthening downward visual gaze/capitol flexion.
  • Developing and strengthening balance of postural flexors and extensors, now in advancing to a diagonal motion.
  • Grasping and pulling feet with either one or both hands.
  • Activating quadriceps muscles as the leg straightens.
  • Stretching out hamstrings from the physiological flexion present at birth.
  • Stretching the toes into extension.
  • Foot desensitization (with the heel pounding that happens when the feet hit the floor again).
  • Tactile input from mouthing, grabbing, stretching; preparing the feet for walking.
  • Developing general body awareness.

When a baby discovers this position, they are becoming experts at rolling to their side.

 

10 Strategies For Filling In the ICF-CY/ NDTA Enablement Model

There are hundreds of medical reports in Kiyoshi’s file.   In addition to oligoarticular juvenile idiopathic arthritis (JIA)  he has uveitis and a seizure disorder.  Kiyoshi has severe pain, joint contractures and difficulty moving around.  Medications are not controlling the inflammation, there have been more seizures lately and his foot orthotics are too small.    How do you begin physical therapy decision-making with a child this complex?

The International Classification of Functioning  (ICF) conceptual framework allows you to apply your knowledge  and skills to challenging situations.  It will take a while to sort information into proper categories and edit. However, once this is complete, connections become clear and sound clinical decision-making will follow.    The question I get asked most often about the ICF is , “where do you start?”.  This post will guide you as you fill in the ICF/NDTA Enablement Model categories for the first time. Continue reading “10 Strategies For Filling In the ICF-CY/ NDTA Enablement Model”

How to Use the Gross Motor Function Measure (GMFM-66)

Freya is a 6-year-old girl with ataxic cerebral palsy.   She moved to California from Iowa last month and has been prescribed six months of physical therapy.   Freya’s parents are concerned; she has been having difficulty going down the front stairs of their new home.  As her physical therapist, do you have a standardized test that will measure her initial gross motor function?   In six months, how will you determine whether Freya has made progress?  

GMFM-66 Quick Facts:

  • 5mo-16 years
  • Cerebral palsy or Down Syndrome
  • Test re-test reliability GMAE-scoring method: 0.9932
  • Most sensitive to change in children 5 years and younger
  • Motor growth curves link

My Gross Motor Function Measure User’s Manual is tattered.  I could not work without the GMFM!    Like all things that are well designed, the creators have taken a complex concept and made it logical and simple.   The GMFM is an evaluative measure that assesses change in motor function over time.  I can test Freya in January,  provide PT 1x/week and then retest in July to determine if she has made significant progress.  In addition, I won’t overlook Freya’s inability to reach across midline while I am heavily focused on her stair skills; the test covers all domains from lying and rolling  up to running and jumping, with each skill being incrementally harder than the last (in the GMFM-66). Continue reading “How to Use the Gross Motor Function Measure (GMFM-66)”

Core Stability: Pushing

 

“My son’s core is so floppy, he really can’t push open the doors when we go to the library.  There is no force through his arms.  Now that he is older, this is stopping him from doing quite a few things”.

Pushing is an essential skill.   To go shopping, a cart must be pushed from aisle to aisle.   A dresser drawer can’t stay open; it must be pushed back into position. We push all day long without much thought about our action, whether it is tidying up the kitchen drawers, pushing a vacuum, going through a revolving door, or moving furniture back into its place. Continue reading “Core Stability: Pushing”