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16

Dynamic
Neuromuscular ABBREVIATIONS:
Stabilization
®

APT – anterior pelvic tilt PR – postural reaction

according to Kolář PPT posterior pelvic tilt COM – centre of mass
UE- upper extremity BOS – base of support
LE lower extremity PCA – post conceptional
Mo, mos – month/s age
ONTOGENESIS W - week IAP – intra abdominal
pressure
CKC/OKC- closed/open
kinematic chain
UD, RD – ulnar, radial deviation

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MILESTONES TIME MILESTONES TIME APPROX.

APPROX. NEWBORN
NEWBORN 0-28d OBLIQUE SIT 7,5 Mo
FENCER 6-8w CRAWLING 8-10 Mo
SYMMETRICAL 3Mo REACHING 8-10 Mo
SUPPORT UNDER THE VERTICAL Age 0-28d
ELBOWS
Asymmetry
LATERAL GRASP 4Mo FREE SIT 8-10 Mo Holokinetic →mass movements
SINGLE ELBOW 4,5Mo CRUISING 10Mo Convexity to either occipital or facial side
SUPPORT Apedal
SYMMETRICAL 6Mo GAIT 14-16Mo No support, rests on Xiphoid occipital side is more
SUPPORT ON THE loaded IN PRONE
PALMS
TURNING 6Mo SQUAT, BEAR 14-16Mo

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NEWBORN
NEWBORN Age 2 days
Anterior pelvic tilt (primitive flexion)
Predilection With limited degree of freedom in the hip which
The child can spontaneously turn the head restricts hip joint (works as a hinge joint)
Eyes move with head – no dissociation Hip/knee flexion with ankle everted
EVEN NEWBORN 2-3 sec optic fixation Hips abd 90°
hips in abducted < 90° (so each hip is abducted 45°) –
lordosis up to T/L junction
Slight reclination and lateral flexing at C Hyperabduction of hips
spine (abnormal) correlated
with kyphosis
of lumbar spine

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NEWBORN
NEWBORN

Scapulae protracted and elevated (cranial/ventral)

Primitive kicking (mainly in supine)
Shoulders functions as a hinge joint
- hip functions as a hinge joint (alternated
FL and EXT) GH IR/extended and arms held in adducted position
- On the leg providing a flexion, foot is providing by the trunk
dorsal flexion, on the leg in extension, the foot
is providing plantar flexion Elbows in flexion (maximally), forearm pronation
- Dorsal and plantar flexion of the foot is Wrist in ulnar deviation and fingers in flexion
available as a part of global movement only

www.rehabps.com GH= glenohumeral joint, IR internally rotated www.rehabps.com

PRIMITIVE REFLEXES
NEWBORN MOTOR RESPONSES MAINLY AT THE SPINAL AND BRAINSTEM LEVEL WHILE THE
CNS IS STILL IMMATURE
Hands: fisted – thumb inside Orofacial reflexes Tonic reflexes
(first 4 weeks) or outside; fist but
no thumb opposition • Babkin reflex • Suprapubic reflex
• Rooting reflex • Crossed extension reflex
• Searching reflex • Primitive support of lower extremities
Arms working mainly in the • Sucking reflex • Stepping automatism
frontal plane - eyes not in • Galant reflex
coordinated with hands contact • Moro reaction
• Lift reaction
• Heel reflex
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PRIMITIVE REFLEXES A FEW EXAMPLES OF PRIMITIVE REFLEXES

M OTOR RESPONSES MAINLY AT THE SPINAL AND BRAINSTEM LEVEL WHILE
THE CNS IS STILL IMMATURE BABKIN REFLEX TIMEFRAME 0-6 W

„grasp-like“ reflexes Only under pathological

condition • Slight push to the root
of the palm towards the
• Plantar reflex • ATNR elbow
• Palmar reflex • STNR • REACTION: opening the
mouth, no other mimic
• Palm root reflex is presented
• Doll´s eye phenomenon • Rossolimo reflex • If stimulation only on
• Acoustic facial reflex • Primitive upright reaction one side, also rotation
of upper extremities of the head towards the
• Visual – facial reflex side of stimulation

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A FEW EXAMPLES OF PRIMITIVE REFLEXES A FEW EXAMPLES OF PRIMITIVE REFLEXES

SUPRAPUBIC REFLEX TIMEFRAME: 0-4W GALANT REFLEX TIMEFRAME: 0-4Mo

• Slight push to the • Positive from the 20th

week of PCA
superior edge of
symphysis • Paraspinal skin
stimulation on the back
• RESPONSE is EXT, – from the level of
IRO and ADD of the lower angle of the scap
legs, plantar flexion, towards TL junction
supination of the • RESPONSE: lateral
forefoot fanning out flexion to the same
of the toes side (spine is moving in
frontal plane)

www.rehabps.com PCA= postconceptional age www.rehabps.com

A FEW EXAMPLES OF A FEW EXAMPLES OF PRIMITIVE REFLEXES

PRIMITIVE REFLEXES
GRASP REFLEX OF THE TIMEFRAME: 0-8/9 Mo
MORO REACTION TOES

• TIME FRAME: 0-3mo • slight pressure under

• 7 ways how to trigger the
• Always extraordinary input metatarsophalangeal
(light, sound, movement,
pulling of the sheet etc.) joints with the foot in a
• Reaction of the arms as neutral position
well as the legs
• NOT ONLY ARMS ! • RESPONSE is flexion of
the toes
• Autonomic reaction
(heart beat, child cries
etc.) Neonatal intensity

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PRIMITIVE REFLEXES – PRIMITIVE REFLEXES –

NEWBORN STAGE NEWBORN STAGE
REFLEX TIME FRAME/ PATHOLOGY
REFLEX TIME FRAME/ PATHOLOGY PHYSIOLOGY
PHYSIOLOGY MORO REACTION 0-6W AFTER 3Mo
SUCKING UP TO 3Mo AFTER 6Mo HEEL REFLEX 0-4W AFTER 3Mo
SEARCHING UP TO 3Mo AFTER 6Mo SUPRAPUBIC REFLEX 0-4W AFTER 3Mo
ROOTING UP TO 3Mo CROSSED EXTENSION REFLEX 0-6W AFTER 3Mo
BABKIN 0-4W AFTER 6W PALMAR GRASP 0-3Mo AFTER 6Mo
DOLL´A EYE 0-4W AFTER 6W PLANTAR GRASP 0-8/9Mo
PHENOMENON
STEPPING 0-4W AFTER 3Mo ACOUSTIC FACIAL FROM 10TH DAY IF NEGATIVE AFTER 4.Mo
AUTOMATISM
GALANT 0-4Mo AFTER 6Mo PRIMITIVE SUPPORT OF THE 0-4W AFTER 3Mo
LOWER EXTREMITIES

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PRIMITIVE REFLEXES – SUMMARY: NEONATE IN SUPINE

NEWBORN STAGE Reclination Unstable
REFLEX Predilection Holokinetic mass
Anterior pelvic tilt → movement
ALWAYS SHOULD BE NEGATIVE*
PALM ROOT REFLEX
Hips in IRO Asymmetry
ATNR, STNR ALWAYS SHOULD BE NEGATIVE
Scapula protraction → Primitive kicking
ROSSOLIMO ALWAYS SHOULD BE NEGATIVE IRO arms, fist, thumb
inside, UD
PRIMITIVE UPRIGHT REACTION ALWAYS SHOULD BE NEGATIVE
OF UPPER EXTREMITIES

* SHOULD BE NEGATIVE FROM THE 40TH WEEK OF POSTCONCEPTIONAL AGE

www.rehabps.com UD= ulnar deviation, IRO= internal rotation www.rehabps.com

SUMMARY: NEONATE IN PRONE SIGNS OF PATHOLOGICAL

Hip flexion up to 115°, Asymmetry
abduction less 45° DEVELOPMENT (REFLEXES) NEONATAL PERIOD
Spine convex on the facial
Head reclination, side
side (mostly) Negative, missing Positive
bending, rotation The child can this position
change (spontaneous • Orofacial reflexes • ATNR, STNR
Anterior pelvic tilt
rotation of the head)
UE protraction (scap), IRO, • Grasp reflex • Rossolimo
No BOS, child passive rests
extension (arm), flexion
on the table • Galant reflex • Palm root reflex
(elbow), UD, (wrist) fist, thumb
in • Supporting reflex of
the arms

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4-6 WEEKS 4-6 WEEKS PRONE

After 4 weeks the child has a longer optical contact= the

Neonatal intensity of primitive reflexes are gone most important initiator of a true uprighting (verticalization in
From this time on they should NOT be positive: gravity field) (Vojta 1974)
Spine is more uprighted
§ Babkin reflex
The head is more lifted on uprighted spine
§ Doll´s eye phenomenon
The child loaded area around umbilicus and forearm (between
§ Stepping automatism distal and medial part)
§ Suprapubic reflex Lifting of the head & support on the forearm & longer gaze &
more uprighted spine = strictly relates to the activity of ventral
§ Primitive support of the lower extremities muscles
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4-6 WEEKS
4-6 WEEKS
¯ Predilection
More activity of external rotators allow the arm be more
developed (or open) to flexion
Head rotates with trunk lateral flexion (SYNKINESIS) Shoulder: ABD up to 45°, FL up to 45°
Head is less reclinated Elbow: 30°FL
Head extended and lengthening of the spine (4-6 Wrist: no UD, no constant fist, thumb out of the fist
wks)
Lifts head still asymmetrically
Driven by emotional need

www.rehabps.com ABD=abducton, FL= flexion, UD= ulnar deviation www.rehabps.com

DEVELOPMENT OF OPTICAL CONTACT 4-6 WEEKS

As baby matures (comparing to newborn):
Less hip and knee flexion, less APT
Nilsson, Hip has now more rotation due to increasing
Hamberger,
abdominal activity
1990
Flexion of hip, knee, ankle (DF) and obligatory
From a few moments on after birth – momentarily with postural
support the child can mimic the face of the other person eversion
later Associated grasp – hands, feet, eyes also
4weeks - 50% children have a optical contact
involved in grasping.
6w- 75% children have a optical contact
ARŠAVSKIJ , KRJUČKOVÁ EXPERIMENT (proof that newborn can see, 1954)

www.rehabps.com APT=ANTERIOR PELVIC TILT, DF= DORSAL FLEXION www.rehabps.com

THE FENCER 6 WEEKS FENCER ATNR

• STIMULUS: optical afferentation • STIMULUS: passive neck rotation
Optical contact and emotion MUST BE STRICTLY • CORTICAL CONTROL • BRAIN STEM CONTROL
of the child is expressed DISTINGUISHED • Facial UE: ERO, ABD, semi • Facial UE: IRO, ABD, semi
in/via posture EXTENSION of the elbow, EXTENSION of the elbow, pronation,
FROM THE ATNR! opened hand tonic fist
The child sees something
and wants to be closer – but • Occipital UE: same position, • Occipital UE: same position, but
MORE flexion in elbow more flexion in elbow
cannot do it – therefore the
fencer pattern is displayed in • Facial LE: EXT, ERO in hip, • Facial LE: EXT, IRO in hip, knee
knee EXT, neutral foot + EXT, plantar flexion of the foot,
substitution associated grasp fanning out of the toes
Disappears around 3mths, • Occipital LE: same position as • Ventrally tilted pelvis
when the child starts to use facial, MORE flexion in the knee
active grasp

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FENCER ATNR ATNR, STNR

PATHOLOGIC
HEALTHY CHILD – DIFFERS:
ERO IN SHOULDERS, OPEN
HANDS, NO TONIC EXTENSION
OF THE LEGS

PATHOLOGY

Kolářová,J., Hánová, P.: VČASNÁ DIAGNOSTIKA HYBNÝCH PORUCH

KOJENCŮ V PRVNÍM TRIMENONU PRVNÍHO ROKU ŽIVOTA.. Pediatr. pro Praxi, 2007; 8(5): 264–267

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E.g. 6 weeks:
TYPICAL REFLEXES IN 6 WEEKS
Grasp reflex of the toes Rooting reflex
Grasp reflex of the fingers Sucking reflex
Acoustic facial reflex Searching reflex
Moro reaction
Galant reflex

Crossed extensor - vanishing

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PHYSIOLOGICAL DYSTONIA – AFTER 8W 3rd MONTH SYMMETRICAL

SUPPORT UNDER THE ELBOWS
Expression of the emotions, desire, excitation –e.g. he wants:
to have a toy, mother to be closer Arms: 90°FL (relating to the T spine), 30°ABD
Sudden movement of the whole body and ER
Should be distinguished from pathological dystonia This is prerequisite for full contact with medial
Quality of uprighting mechanisms must correspond to condyle humeri
developmental age Elbows: 40-45°FL
Positive as in– he wants to move towards the toy (no tools for that)
Negative as in– he wants to move away from the stimuli, towards the Fingers: semiflexion
surface of the bed
Spine: axially extended to the TL junction,
potentially free rotation in between segments
Pelvis: dorsally tilted
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3Mo SYMMETRICAL ELBOW SUPPORT

C SPINE –
3rd MONTH SYMMETRICAL
SPINE IS
AXIALLY BALANCE

SUPPORT UNDER THE ELBOWS EXTENDED,

ELONGATED
BETWEEN THE
DEEP NECK THE EYES ARE
FLEXORS AND TURNING 30° TO
• The head is able to provide free rotation (not EXTENSORS EACH SIDE
coupled with the side bending of the trunk) PELVIS IS PULLED INTO
NEUTRAL POSITION
• The eyes are able to move to the side without (ABDOMINAL MUSCLES) HEAD IS
any movement of the head (isolated mvt< 30°) TURNING WITH
NO SYNKINESIS
• BOS: triangular – elbow- elbow -symphysis LEGS ARE
FREE, HIP
• Legs: free, no held in specific position CAN NOW BOS = TRIANGLE
• Hip works as a socket joint WORK AS (ELBOW-ELBOW
A SOCKET SYMPHYSIS)
• Upper part of the trunk: lifted from the JOINT
surface (towards the fixed scapulas) RHOMBOIDS BICEPS, TRICEPS SERRATUS
ANT. LIFTING
PULL TOWARDS STEERING THE THE TRUNK
THE SCAPULAE SHOULDERBLADE TO THE SCAP

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3M SUPINE
Child 3 Mo old, angle
between T spine and the • Cylindrical (barrel) shape of the abdominal wall
arm is 90° • Arms - ERO
• Hand-hand contact, hand –hand-mouth
• Phantom grasp (object may or may not be
there)
• Rests on activated
Child is younger than traps between
3Mo. Angle is acute shldr blades

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3M SUPINE CHILD CAN HAND EYE MOUTH COORDINATION

CONTROL IAP
HAND-HAND coordination
PELVIS IS IN SYMMETRY IS is the beginning of the
NEUTRAL ACHIEVED, CAN SPINE IS AXIALLY
POSITION STOP THE MVT
development of the body
EXTENDED,
ELONGATED, scheme
CHILD CAN POTENTIALLY
SEPARATE THE ROTATED, no C spine
reclination
RIBS, CAN
BREATH TO THE
LOWER 6
INTERCOSTAL LEGS HELD ABOVE THE
SPACES SURFACE EASILY

BOS – DIAMOND SHAPE, C ROTATION IS ABS CONCENTRIC

BETWEEN THE HEAD- REACHES THE ACTIVITY
SCAPULAE- L/S JUNCTION T3 SEGMENT

IAP = INTRAABDOMINAL PRESSURE www.rehabps.com www.rehabps.com

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TYPICAL REFLEXES AT THE END OF SUPINE 4M

THE FIRST TRIMENON
The child older than 3Mo starts to use lateral grasp, grasp
from the lateral side of the body (also named ulnar grasp)
§ Acoustic-facial Hand opens from the ulnar side
reflex Voluntary grasp
§ Visual facial reflex While the child is grasping, the legs are above the table
Arm is extended out with axially extended cervical & thoracic
§ Plantar reflex spine
§ Palmar reflex Pelvis is oblique axis positioned in the frontal place (isolated
segmental movement)
(weak) Lumbar spine/pelvis will move either to convexity or
concavity
§ Galant reflex
(weaker) SOLE-to-SOLE contact → FOOT-FOOT coordination (Both
occur with lateral grasping)

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SUPINE 4M
PELVIS MOVES IN
SPINE AXIALLY
ELONGATED HEAD IS This child can grasp laterally
FRONTAL PLANE – DIFFERENTIATED PART
ISOLATED OF THE
MOVEMENT BOS

LEGS HELD WELL BALANCED

ABOVE SURFACE ACTIVITY
BETWEEN DEEP
NECK FLEXORS,
L SPINE SHOWS ABDOMINAL EXTENSORS
CONVEX TO FACIAL MUSCLES -
OR OCCIPITAL SIDE DIFFERENTIATED
The quality of the lateral grasp always depends on the spine.
HANDS OPEN, ARMS CAN Grasp is a global model, from the beginning of grasp the
PELVIS IS HELD IN NEUTRAL
PROVIDE FL, HOROZINTAL child has a mouth open. Legs are above the surface.
POSITION (VIA ABS)
ADDUCTION

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CONSEQUENCES SINGLE ELBOW SUPPORT 4,5m

To be able to grasp Single elbow support is developing
voluntarily (4Mo), from the symmetrical elbow support
grasp reflex of the § Spine C and T: is segmentally
hand should vanish or rotated towards the grasping arm
be really weak § Lumbar spine is in convex on the
occipital side
At the age of 6Mo, this § BOS: triangular, elbow, on the
reflex should be same side upper thigh (or pelvis)
and on the other side the knee (red
absolutely negative line)
(support under the
palms is presenting)

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4,5M SINGLE ARM SUPPORT 4,5M SINGLE ARM SUPPORT

FROM DORSAL ASPECT RHOMBOIDS, TRAP
§ Grasping arm and the
PULL THE SPINE TO THE SCAP= ROTATE THE
head are held out of the TRUNK TO THE SUPPORTING SIDE SUPPORT, MUSCLES
BOS ARE PULLUNG
OPEN KINEMATIC CHAIN, TOWARDS THE
§ Grasping arm can ELBOW, CLOSED
PHASIC FUNCTION; FLEXION
provide isolated grasp up MORE 90°/LESS 120° KINEMATIC CHAIN
to 120°FL and 60°ABD in
glenohumeral joint, ABDOMINAL HOLD TRUNK RELATIVELY
30°above the surface THE CHEST AND NEUTRAL IN
PELVIS NEUTRAL TRANSVERSAL PLANE
(SAGITTAL PLANE)
FROM VENTRAL
§ Galant reflex in negative HAND IS LIFTING
PART OF THE CHEST:
(spine is steering not only 30° ABOVE THE
PECT MJ =
in frontal plane) SURFACE – MVT IN ANTIGRAVITATORY
SPINE OCCURS IN PECT MJ ROTATES THE
FUNCTION
TRANSVERSAL CHEST TOWARDS THE
PLANE SUPPORTING SIDE
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CROSSED PATTERN
= TYPICAL FOR
UPPER PART OF HUMAN BEING
4,5Mo THE SPINE
ROTATE TWDS
LOCOMOTION
SINGLE ELBOW SUPPORT 4,5Mo
THE SUPPORTING SPINE AXIALLY
ARM EXTENDED, What is new here?
ELONGATED (comparing 3Mo)
LUMBAR SPINE
IS IN CONVEX TO ABDOMINAL
MUSCLES WORKING § Spine
THE OCCIPITAL
SIDE IN DIFFERENTIATED § Function of the extremities
WAY, TWO OBLIQUE
CHAINS § Ventral muscles
PELVIS IN SAGITTAL
PLANE NEUTRAL, IN SUPPORT UNDER THE
§ Muscle pull
FRONTAL OBLIQUE KNEE, ANGLE IN THE § Pelvis is cranially shifted
HIP DEPENDS ON THE on the facial side
ABILITY TO UPRIGHT
BOS TRIANGLE THE PELVIS OVER
§ Very first support on the
THE SUPPORTED lower extremity
FEMUR

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5 Month SUPINE
SINGLE ELBOW SUPPORT 4,5Mo
HAND-GENITAL
IF THE CHILD CAN EXHIBIT THE SINGLE ELBOW HAND-KNEE Coordination
SUPPORT FROM THE BOTH SIDES AT THE AGE OF
4,5Mo (IN A PROPER QUALITY!!) 4,5Mo by end of 5th month - reaching over the midline
Pelvis will always be asymmetrical. When weight shift goes
to the other side and becomes a support, the pelvis will NOT be in
WE CAN SAY: midline, and the pelvis shifts cranially to occipital side.
• THE CHILD IS HEALTHY
Reaching with hand fully open with RD with reaching
• THE CHILD WILL BE ABLE TO WALK past midline
4,5Mo PATTERN IS CRUCIAL FOR OUR GAIT, Forearm isolated movements (pronation x supination) –
CRAWLING, CLIMBING, RUNNING, ALL MODES OF development of stereognosis
LOCOMOTION (Vojta)

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HAND KNEE, SOLE TO SOLE

HAND KNEE displays at
5Mo
SOLE TO SOLE from 4th
Month

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SWIMMING 4,5 - 6Mo 6M PIVOTING

The child in prone position, Turning around,
symmetrical support on the palms, REQUIRED TO THE
cannot reach the toy in the midline BOTH SIDES
→ cannot use the hands for grasping
On the belly button
→ cannot decide which hand use
Result: the child displays the
swimming pattern – the mouth as a The leg can rest on the
grasping organ- is approaching the side during the
toy movement, but it is not
The child salivates purposeful movement of
the leg to the side

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SCAPULAS HELD,
SYMMETRICAL 6. Mo TL JUNCTION IS
UPRIGHTED
STABILIZED
HAND POSITION OVER THE
HUMERAL HEAD
PRONE SUPPORT UNDER
THE OPEN PALMS,
Hip is loaded in 0°of flexion cannot take one PELVIS HELD IN
TL junction is stable (psoas hand off
NEUTRAL: PUBIS
x diaphragm) GOING CRANIALLY,
Costal breathing DIAPHRAGM TUBERS CAUDALLY
Defecation FLATTENS A THE
Speech development FIBRES ARE PULLING
FROM THE CENTRUM M.PSOAS IS PULLING
BOS rectangle TENDINEUM TOWARDS THE
On the hands and knees TO THE RIBCAGE TROCH.MINOR
SUPPORT ON THE
No forward locomotion DISTAL THIRD OF
COSTAL BREATHING THE FEMUR
BOS RECTANGLE
IS FULLY EXPRESSED

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SYMMETRICAL SYMMETRICAL HAND POSITION

HAND SUPPORT PRONE
Child can now see a larger
horizon – d/t higher elevated • 6 month position hands and
position thighs support
(quadrangular – for a mvt
3-D perception is developed – forward doesn´t work in
at first it is accidental, but locomotion)
when he discovers the larger • BOS – open hand
horizon, he will do it abduction of metacarpals
consciously (broad hands) and mid
Salivation – desire for the thighs
object
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SYMMETRICAL HAND POSITION 6MO

PRONE HOMOLOGOUS
POSITION
Scapulae held over the humerus
head – shldrs are not IR
4-point kneeling/quadruped
rocking back & forth (7
Upper arm over hand but with
elbows in easy position (not month of age)
hyperextended)
Normally this skill (rocking)
Post pelvic tilt with massive lasts 2-3 weeks
concentric ventral muscle activity
with free movement of legs.

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6 months

SYMMETRICAL HAND POSITION

PRONE
Weight bearing over open
hands – grasp reflex in hand
should be completely
negative
Collis horizontal (PR) at the
age of 6Mo corresponds to
this-
The palm is open and in full
contact with the surface

PR= postural reaction according to Vojta www.rehabps.com www.rehabps.com

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WELL
COORDINATED
ACTIVITY OF
3 „DEAD END STREETS“ IN THE DEVELOPMENT
TURNING VENTRAL AND
DORSAL
MUSCLES
1) Symmetrical hand OBLIQUE
support ABDOMINAL IPSILATERAL
CHAINS PULL TO PATTERN
2) Swimming pattern BOTTOM SHLD
AND HIP PELVIS IS HELD IN
3) Homologous NEUTRAL
quadruped position HEAD WILL BE
POSITION (POST.
TILTED)
LIFTED AND HELD
IN THE
LONGITUDINAL SPINE AXIALLY
AXIS ELONGATED

EXTREMITIES
ENDING POSITION DIFFERENTIATED
IS PRONE
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2nd Trimenon TYPICAL FOR THIRD TRIMENON:

is absolutely • Oblique sit
crucial for • Quadrupedal
human locomotion
Tripod
locomotion
•
• Start to observe the
vertical plane
Skills, patterns from 2nd trimenon are prerequisite for • Weaker grasp reflex of
reaching the vertical plane in next trimenon the toes
• Negative Galant reflex

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FOOT-HAND-EYE-MOUTH FOOT-HAND-EYE-MOUTH
Coordination 7Mo COORDINATION
• Segmental grasping of
the feet develops

• Feet can be used for

grasping or to manipulate
objects
• The child is able to lift the
legs via abdominal
activity, no just grasp and
pull by the arms

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SEELING CHILD IS OLDER 7MO 7MO

For short period of time § Symmetrical
Mvt forward, generator of support on the
power are the arms palms + the child
Using the pattern of single can step forward
arm support the child is with the one leg
moving forward, arm goes up
to 120°FL § From this position
Legs can stay relax or can
the child lifts the
help a bit left arm to reach
the toy
Not every child is sealing
(not an economic way to
move)
NOT IDEAL SUPPORT UNDER THE PALM
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LOWER OBLIQUE SIT= SIDE

OBLIQUE PROPPING
SIT
Milestone, it comes
Propped-lying on in the middle of the
the side third trimenon
(7,5Mo)
Support on the
ipsilateral The child is stabile
elbow/forearm and enough (and
pelvis/thigh/knee motivated) to go up
in frontal plane

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7,5M OBLIQUE SIT 7,5M OBLIQUE SIT

§ Upper lying hand free Head is held up in
- now more FLEXION longitudinal axis and
135° versus 120 earlier on maintained in the frontal plane
§ Axes ARE ALMOST
PARALLEL, upper ASIS is
Side-siting on elbow or open
a bit cranially, child can hand at 7 ½ months
provide isolated mvt of the depending on where the toy is.
pelvis in frontal plane from
the age of 4,5Mo
50% of babies – side sitting at
7 ½ months.

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7,5Mo SIDE PROPPING

SCAPULA IS
FIRST TIME IS HEAD FIXING POINT IPSI PATTERN
7,5M OBLIQUE SIT HELD IN
LONGITUDINAL AXIS
FOR SERRATUS
ANT
IN FRONTAL PLANE
Elbow extended with ARM UP TO 135°,
COMBINE WITH THE
open hand – supported SLIGHT CONVEX ERO AND ABD
on buttocks, iliotibial tract TO THE
to lateral knee. UNDERLYING SIDE
OF THE BODY PELVIS POSTERIORLY
Pelvis PPT , convex on (CONSTANT) TILTED, IN FRONTAL
bottom side and concave PLANE
on top side CHILD IS
HIGH
DICOVERING
COORDINATION
NEW SPACE PROPPING ARM BOS : HAND-
time baby can stop
1st BETWEEN
BELONGS TO BUTTOCK – VENTRAL AND
moving in space THE ILIOTIBIALIS DORSAL
SYMMETRICAL TRACTUS MUSCLE GROUP
HAND SUPPORT
PPT= posterior pelvic tilt www.rehabps.com www.rehabps.com

At end of 7 ½ months – LONG SITTING (8-10MONTHS)

PINCER GRASP TIP to Immature free sit – infantile
TIP (PAD to PAD) kyphosis can be observed
Mature sit: T/L junction completely
axially extended (should not sit
baby up before this is voluntarily
Pad to pad – thumb achieved)
opposition to index
finger (motor
After 8M free sit is just transitional
consciousness at the position between crawling, oblique
end of the acrum) sit and verticalization

Acrum= distal part of the extremity www.rehabps.com www.rehabps.com

LONG SITTING (8-10MONTHS) TRIPOD - 3RD

TRIMENON
Hands are free to play to
manipulate objects J
Weight on both ischial
tuberosities
Transitional position
Different ways of leg
placement
„W“ sit is
not recommended L
J

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TRIPOD
TRUNK CHEST TRANSITIONAL
SPINE PELVIS IN
NEUTRAL POSITION
POSITION CRAWLING
CONSEQUENCES –
FORCES TRANSMITTED
TO THE SPINE

3 POINTS OF
SUPPORT

CAN CHANGE POSITION,

DIRECTION, SPEED VERY
QUICKLY

GRASP REFLEX OF
THE TOES WEAK OR ERO IN HIP –THE FOOT
NEGATIVE CAN BE LOADED MORE
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IMMATURE Immature reciprocal crawling 8-

CRAWLING
10months - can be 2 point or 3 point MATURE CRAWLING
support
Combination of a trot and amble R Mature reciprocal crawl
arm R leg and then L leg
Foot is loosely
• characterized toes flexed/foot plantarflexed – no longer
everted with hip and knee toes dorsiflexed
flexion
No longer see the cranial
• cranial movement on the mvt of pelvis and side
stepping pelvis – convexity of flexion of lumbar spine
LS
Shin more in contact with
head always follow the stepping arm surface
human infant quadrupedal 115-117º
shoulder flexion (Vojta 2010)

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CRAWLING WALKING ON THE STEPS ON THE HANDS

AND KNEES
AMBLE GAIT – 4 point crawl
TROT – contralateral 2 point
Situation when the
crawl (mature crawl) child is „walking –
crawling“
Humans are the only species Trunk is more
that use our hands and knees vertical (closer to
to crawl before walking the gait)

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VERTICALIZATION (AGE 8-10MO)

CRUISING= FRONTAL GAIT 10MO
The arms are literally the This is the first time the
motor for the first foot is loaded with
movements in a vertical influence on its arches
plane The side walk is called:
COM can gradually be coordinated pattern in
more easily shifted to one contra lateral manner
Contra lateral arm starts to pull the body up, side of the body→ arm is Grasp reflex must be
The foot is placed at the same level as the supporting knee more loaded as well as gone and deep foot
(pelvis is moving a bit cranially on this side)
the one LE =triangular sensation is initiated
Abdominal muscles pull the symphysis cranially→ so the body BOS (feet + arm)
is lifted vertically up
The arms are the main power generators for lifting the body
up (not legs)
After completing the lift is the other foot loaded (equally)
www.rehabps.com COM= centre of mass www.rehabps.com

CRUISING THREE POINTS OF

SUPPORT BEFORE
CRUISING
When the child is able to
walk around the furniture
just with one arm
support, we can soon
Frontal gait -quadrupedal locomotion in vertical plane expect free gait in space
(Vojta,2004)
CRUISING – sidestepping is always 3 point support
(10-13 months) CONTRA- LATERAL SUPPORT
Frontal plane walking. Leading with arm, not legs.
More awareness of the legs but cannot free up the arms
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9-10 months
SUPPORTED STANCE WITH
TRUNK ROTATION

Usually after a month of

cruising

Can have a free arm and

rotate trunk in space (IPSI
PATTERN)
Can bear weight much more
on the legs – weight shift.

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BEGINNING OF THE GAIT 10-12 MOS FREE INDEPENDENT WALKING (14-16 months)
• Able to take steps in sagittal plane and stop and change
At this age the child can go direction
from one piece of furniture to • High guard (slightly retracted scap and pelvis not completely
the other uprighted – this is physiologic APT)
This position is very dependent • This disappears at
on motivation and about 3 years old.
The final adult spine
CONFIDENCE on trusting the curves is during
leg adolescence.

THIS IS NOT INDEPENDENT GAIT

www.rehabps.com APT anterior pelvic tilt www.rehabps.com

FREE INDEPENDENT WALKING

INDEPENDENT GAIT
(14-16 mos)
Free gait means
• Wide based. Foot flat or • The child can stop
forefoot contact but not heel • The child can change the
contact yet. direction of the gait
• Longitudinal arch not • The child can change the speed
developed. Heel contact will
begin at 3 years. INDEPENDENT SOCIAL GAIT
MATURES 14-16m
• Correlated to ability to stand 14m 50%
on 1 leg, ability of pelvic 16m 90%
extension and uprighting of
18m 100% CHILDREN WALK
spine in longitudinal axis.
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SQUAT
THE BEAR GAIT 14MO
Child can squat when he/she can stop the gait in the space
The knees never go in front of the toes Contra lateral
Homologous pattern, both legs CKC pattern

The child is placed

contra lateral hand
and foot to support
and the other
extremities are free
to make the step
forward

CKC= closed kinematic chain www.rehabps.com www.rehabps.com

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Dynamic Neuromuscular Stabilization 18