Please note: In order to facilitate a smooth, coherent comprehension of the text, it has been decided to refer to the child using masculine pronouns only. Acknowledgement of both male and female children throughout the text fragments the message and disrupts comprehension of the whole. Please feel free to substitute pronouns of whichever gender are appropriate for your situation.
1. What is Motor Development?
Motor development is the development of movement. The ability to move is essential to human development. Many motor skills are necessary for everyday life activities e.g. sitting, walking, running, climbing stairs, picking up objects, using cups, knives and forks, pouring drinks, dressing, holding and using pencils, pens, scissors and using keyboards. Basic motor skills can be further divided up into
• Gross motor skills that are large movements of the body including sitting, walking, running and climbing stairs.
• Fine motor skills that involve the small movements of the fingers and hands. They include picking up objects, using cups, knives and forks, pouring drinks, dressing, holding and using pencils, pens, scissors and keyboards.
Movement can be seen and felt and a delay in motor development is usually the first sign of a real problem because it is noticed far sooner than a problem with seeing, hearing or communication. Motor development seems to follow a pattern. Large muscles develop before smaller ones e.g. very young children find it easier to run than cutting with scissors. Children also tend to develop in a head-to-toe pattern. For instance, babies move their eyes, head and hands long before they learn to crawl.
2. Why should we know about motor development?
- New behavior is made possible when a child’s body develops e.g. a toddler can be toilet trained once the necessary anal sphincter muscles have developed.
- So many new experiences and learning opportunities are opened up when the body is able to do more e.g.
- being able to hold the head firmly in the midline means the child can focus more easily on an object. It also means the child can now develop hand/eye coordination, a very important skill needed for independent living.
- being able to reach and grasp means a child can begin to learn about objects in his world o being able to sit means more use of the hands and arms for playing (and therefore learning). It means the child can begin to learn about his position in space. Sitting is an essential skill if the child is to eat easily, dress himself, get the attention of others when speaking, look at computer screens, television etc.
- being able to crawl increases the child’s learning opportunities. It means he can touch things that were only visible before, so much more can be learned about how much space his body takes up by crawling into, under around and over objects.
- being able to walk means a child is able to carry things. It also means the child can explore and experience more in his environment than before.
- being able to move independently means a child has more opportunities for social interaction and language learning. Because children can now follow their caregivers from place to place it means they can be talked to and included in more everyday activities. They can run, jump and catch a ball and play with other children, socialising and making friends.
3. How does motor development happen?
It goes on all the time from conception until the late teens. At the same time, the nervous system matures. Any movement means the brain; nerves and muscles have to work together.
3.1. Obstacles to motor development:
We can do nothing to influence the maturation process and a child cannot walk before the nervous system is ready for it to happen. But if we do not give a child enough opportunities to practice movements and move about, we can slow down development. I.e. a child will not be doing what he should be doing at his maturational level. While everybody is different and develops at different rates, abnormalities in the muscles, joints and/or nervous system will result in delayed and/or abnormal development. Other obstacles that may affect motor development are as follows:
• Health issues may also account for individual differences in progress as children with disabilities may not have the resilience to compensate for them.
• Visual impairments may reduce feedback on position, and depth and distance perception.
• Hearing impairments will make following instructions more difficult. • Uncorrected heart abnormalities may considerably reduce energy and stamina.
• Children who are overweight will not feel much enthusiasm for exercise and may even find it uncomfortable. At first, movement in the very young baby appear haphazard and disorganised. All the joints of the arms and legs are flexed. Primitive reflexes such as the Moro reflex and the Grasp reflex are also present. These disappear as the nervous system matures, movement becomes more organised and meaningful and the child develops. The child first learns to control and support his head in all positions. Another important development is learning to bring his hands together in the midline, beginning to reach for objects and to grasp them. A variety of different movements will now develop and the child learns to roll over from his back to his tummy and back again. He will also be able to sit alone at this stage. Most children learn to crawl and to kneel before they are able to pull themselves to a standing position, balance themselves while standing and finally walk without help. (Remember! All children are different and not everyone crawls, but eventually walk well.)
4. How should movement be encouraged?
Children should be encouraged to move and achieve their maximum potential. When we encourage movement, we must remember that movement develops from top to bottom. In other words, the child has to learn to control his head before the arms and legs can be controlled; and to control his body before walking. It doesn’t matter if the child is three or four years old, if his head control is poor and if he cannot sit or walk, we should start by encouraging this child to develop head control. An older child who is still immobile can be encouraged to stand with support but more as a strengthening exercise and also so that the child can experience the standing position. Activities Here are just a few ideas for strengthening the head and neck muscles.
• Always start with a good position.
• If you are working with a baby, bend his knees up and separate his legs. Bring his shoulders forward and turn his arms slightly outwards. Then slowly lift the child and his head should follow.
• When working with a bigger child, be careful not to place your hands behind his neck. Your hands should be behind his shoulders. Place a wedge or rolled up blanket under his head. Separate his legs with your own knee or arm. Bring his shoulders forward and pull him up into a sitting position keeping his arms turned slightly outwards. As he gets stronger, lift him up holding only his hands.
• Use this activity every day as you lift the child up from a sleep or after changing a nappy. Make a game of it by lifting the child up and down a few times. Always try to make the activities fun for both you and your child. Remember, the child may have to get used to new positions before you can introduce new activities.
• When family and friends are gathered together, place the child lying on his side. Have the leg underneath bent and the other leg straight, supported by a pillow or a folded blanket. In this position it is easier for the child to keep his head in the middle and to get his hands together. He can then look at his hands. (See later notes on fine motor development.) Sit on the floor with the child when he is in this position if other children are playing on the floor, or in the classroom.
• It is also important to place a child on his tummy whenever possible as this activity helps the child develop a strong back for sitting, crawling and walking. Support him under his chest by using a rolled up towel/blanket or with your hand. Encourage the child to lift his head by talking to him from the front and by having a noisy toy in front to look at. The child’s arms must be forward and at first you may need to place one hand on his bottom and press downward to get his hips flat. Lift the child’s shoulders up and encourage him to lift his head, lean on his arms and then play with the toy.
• The child will then progress to activities that will encourage him to roll and then to sit. Eventually the child may be able to kneel, then stand and finally walk, even if it is necessary to be held and supported while doing so.
• The way a child is reared will have an effect on the development of movement. Able-bodied children are usually given many opportunities for their muscles to strengthen and develop. Parents feel secure enough to ‘experiment ‘ and try and see when the child is capable of supporting his head alone or sitting. Yet parents can become over protective when their child experiences a problem or is slow to develop and give too much support. This can further delay development. For example a mother of a child with cerebral palsy always leaves her child lying flat on his back (to the extent that the child becomes bald at the back of his head) and never gives the child any opportunity to try and lift his head. The muscles in the neck are not allowed to develop any strength and the child is prevented from learning how to hold up his head.
• Another example can be seen in the way we hold the child. At first, he may need a lot of support. E.g. when the child sits, he may need to lean his entire body against that of his mother while sitting in her lap, with her arms containing him. Later, the child may be able to sit with only one hand being held.
• Movement happens when a child is stimulated to move e.g. when burnt by something hot or pricked by a sharp object. It can also be a response to a command e.g. “Come to me” or “Take your toy”. We should therefore talk continuously to children about what they are doing in order to explain and mediate the experience for them. All children need to experience touching and moving different toys in order to learn and develop further. Such experiences should be made possible for them whenever possible.
• Do not move suddenly or quickly, with jerky movements when handling children with physical disabilities. Children with stiff or spastic muscles seem to respond best to slow, deliberate movements, while the floppy or limp child needs faster movement.
• Get to know the likes and dislikes of the child. Some children do not like moving if it is too hot or too cold. They may object to the surface on which they have to move – it may be too hard, or too soft, prickly or uneven. Noise levels in the area may affect the reactions of children who are sensitive to sound. Children will not cooperate and respond to encouragements to move if the atmosphere is stressful for any reason. If the caregiver/mother or even the child is tired, irritable or over-anxious, efforts to stimulate movement usually fail. Sick children will certainly not want to move.
• Continue to work with the child for as long as the child responds happily and cooperatively. If the child loses interest, becomes irritable and stops cooperating, the session should end. Remember, initially even a little physical effort can be exhausting for a child experiencing a disability. If a child is expected to do too much each time, there is a risk that he will associate such sessions with negative feelings and resist them. This can become a real barrier to developmental progress. However, there needs to be a balance as too little exertion and challenge can lead to boredom. Children with disabilities will usually be given fewer opportunities to practice than able-bodied children yet we are constantly comparing them. We need to bear in mind that practice improves motor skills until the best possible level of skill is achieved which does not improve any more.
5. In summary:
• The best way to improve all types of movement is practice.
• Children with disabilities need more practice to improve movements than other able-bodied children.
• Help babies to practice activities that need strength and balance like sitting and walking by supporting them while they practice.
• Try and make plans to compensate for the social and cognitive effects of late movement.
• Encourage as much active movement as possible in natural ways through play and activities such as swimming, gymnastics and outdoor games.
• Teach by visually demonstrating or modelling the actions.
Written for Down Syndrome South Africa by Dr Gill Lloyd
Acknowledgements Ideas have been used throughout this section from a number of publications: Goodman M. and Katz B., 1998, “Cerebral Palsy Caring and Coping”. Witwatersrand University Press. Sacks B. and Buckley S., 2003, “Motor Development for individuals with Down syndrome – An overview”. The Down Syndrome Educational Trust. START Home Intervention Programme, 1990, Sunshine Centre Association