Month: January 2016

#MilestoneMonday / Walking Part II

As previously discussed, standing is a critical piece to a baby’s gross motor skill and physical development. Perhaps above all, its an additional means that allows a baby to explore and interact with their environment. This week, we will discuss activities that standing with support and independent standing can be facilitated.

Early on, (i.e. in the first months of life) prone positioning, or ‘tummy time’ is an important strengthening activity to practice. Although at this point, standing is not a short term goal to learn, it is valuable to emphasize the importance for spending some time in prone. This is because laying on the abdomen gives babies a chance to work on the strength of their extensor muscles through their hips, back, and neck. This is so important because these muscle groups are essentially their ‘anti-gravity’ muscles that will provide the necessary strength to achieve and maintain standing. Given this, I realize that tolerance for ‘tummy time’ for some children is limited. In this case, it is important to gradually build their tolerance for this position and present them with activities, toys, and faces they can interact and explore to create a positive experience. Additionally, providing support at around chest level can be used to reduce the strength requirements for prone positioning. This can be done with hands at the chest level and under the arms or a rolled up towel or soft stuffed toy in the same position.

For early standing activities to encourage weight to be taken on the feet, support should be provided at the chest and under the arms. In this position, it should feel as though the child is providing resistance at their legs to remain standing, but cannot quite take their full weight. In this position, you can be facing each other or in the same direction, depending on the baby’s attention and interest. While working on this standing with high support position, you can sustain a stand for longer if they are playing with a toy, or if they enjoy movement, you can work on bouncing on this position with your hands guiding the movement, but allowing them to participate by pushing through their feet. As their strength and balance improve, the goal is to reduce the amount of support that is provided by moving the hands from the chest to the waist, and then to the hips. This way, the amount of weight that they must manage is increased, in addition to balancing their trunk above your hands to maintain standing.

Also, a great way to get more weight bearing on a baby’s legs to play in a kneeling position at a support surface such as a couch. This position gives significant input into the hips, namely, the gluteal muscles that are powerful extensors of the hip. When performing this activity, you may find that the infant may alternate between high kneeling and low kneeling (on the knees, but the buttocks resting on their heels). This is a great activity because they are actively using their hip extensors to bring themselves into an elevated position, thus working on anti-gravity strength at their hips.

As the baby develops their strength and they are looking to become more independent, standing at a support surface may be an activity that would be appropriate. This is significant step, because again, this promotes the independence of the child to allow them to be more explorative. Initially, their positioning will be square to their supportive surface (as previously discussed in the previous post). Here, we want to work on the ability to manage small weight shifts left and right and ultimately master movement in the frontal plane. This can be facilitated by providing support at the hips, and guiding their weight to shift left and right; combine this with toys or objects the child likes just within their reaching range, and they will begin to learn the value to weight shifting to extend their exploration abilities.

As with all activities that involve strengthening, be sure to monitor the infant’s tolerance closely. If you find that new activities require a big effort, then short and frequent bouts of activities may be more tolerable.

For the next post, we will talk about strategies for transitioning into a standing position from the ground.

By: Chris Dahiroc P.T.

If you have any concerns or questions contact us to book your free 15 minute meet & greet today!

#MilestoneMonday / Standing

Gaining verticality is an exciting perspective for your developing baby. Like sitting up, this opens up more possibilities for interaction and discovery. Weight bearing on their feet against gravity is also a major stimulus for babies’ musculoskeletal development. Additionally, standing can be viewed as a precursor to stepping and walking. Independent standing is usually learned near 12 months; however, the work towards standing alone begins with standing with support, which is much earlier. Standing at a supportive surface is typically learned at 6 months.

Before one can learn how to stand independently they must first master their base of support, and how their centre of balance interacts with their movements within this area. To simplify this relatively complex interaction, it is best to minimize the number of degrees of freedom of movement that the baby has to account for when trying to stand. For reference, we can move in three planes; they are the sagittal (front and back), frontal (side to side) and transverse (rotation) planes. This is achieved by the supportive surface. For an early stander, they would be facing squarely to the surface, with both hands firmly placed on the support. This position removes the balance requirements that the baby is required to account for moving forwards and backwards (in the sagittal plane), and rotating left and right (in the transverse plane).  This leaves only lateral weight shifting movements to the sides relatively “free” (in the frontal plane). Yet, as we will learn, babies seem to be built to have some inherent stability in the frontal plane to facilitate learning movement in this plane.

When a baby is attempting to stand at a surface, one may notice that the baby’s feet are quite widely spread. Early in the baby’s skeletal development, their alignment through their legs are actually biased to have to be wider to be more stable when weight bearing.  In fact, a baby may appear to be “bowlegged” early in their alignment, but this is to be expected, because as they physically mature, this alignment is expected to resolve into a more neutral alignment where their feet are narrower and legs have a straight appearance. However, this immature alignment effectively widens the base of support and lowers the centre of gravity, thus making the child more stable. Thus, this developmental stability allows for slight weight shifting movements left and right that the child can explore when standing at support. As a result, the first component of standing that a baby will learn is mastery of the frontal plane in standing, or, weight shifting left and right in standing. Yet, this makes a lot of sense that they would achieve this first, because weight shifting left and right is a critical component of walking; taking the full weight on one foot is necessary to unweight the other foot for movement. Mastery of weight shifting allows the baby to learn and explore cruising steps left and right, and ultimately culminates in taking steps forward.

Also, when learning how to stand at a support, there is the additional layer of the strength that is needed to support their bodies in a position where they are weight bearing on their feet. This means that their anti-gravity muscles through their legs and trunk must work in synergy to achieve standing. Early on, when standing at support, their arms must also work in unison with the rest of their body to maintain standing. It will be difficult early on to maintain standing, so babies tend to hold on to their support surface with everything they have; they will hold on with their arms, and may lean their trunk against the supportive surface. For some with gross motor delays, this tends to persist well passed 12 months, where they prefer to rest their bodies against a support surface. Although this may be a functional position, this eliminates the use of their trunk and leg muscles to provide them with balance when they are standing. Thus, an important strengthening opportunity is missed.

In the next post, we will discuss activities that can be performed to facilitate standing at support and standing.

By: Chris Dahiroc P.T.

If you have any concerns or questions contact us to book your free 15 minute meet & greet today!