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Home | Articles | Intervention

Brain and Body: Gross Motor Skills

Learning new motor skills creates important neurological connections in brain cells and allows for habitual patterns of movement. For children with deficits in gross motor skills, typical physical, social and emotional development may be affected.

Children love to move!
It is the primary way they explore their environment and discover the world. For the typical child, movement comes naturally. Crawling, walking, running and jumping all happen as the developmental plan unfolds. However, some children experience problems, and critical steps in gross motor development are missed.

Gross versus fine motor skills
Gross and fine motor sequences are the two different motor patterns that allow children to adapt physically to their surroundings and perform activities necessary for daily living. While fine motor sequences involve the smaller muscles of the body (hand muscles to grasp objects, face muscles to chew), gross motor movements of the body involve the large muscle groups, such as for sitting, standing and walking. From infancy, children use gross motor patterns to crawl, roll, jump, hop, skip, climb stairs, balance on narrow surfaces, and countless other activities that seem to come naturally, but are actually a complex developmental pattern of neurological connections between brain and body.

Gross motor movements are produced by the brain’s signals through the nervous system to the muscles involved in a particular action. Motor skills are executed through the motor cortex, a part of the brain’s cerebral cortex, and through those areas associated with memory and learning. The brain works to “teach” the body the motor sequence. Children are born with a certain number of brain cells designated specifically for certain actions such as breathing, circulation of blood, and more complicated executive tasks and activities.

GROSS MOTOR MILESTONES
FOR THE FIRST YEAR

Age In Months Gross Motor Skills
Newborn Bend and straighten arms and legs, lift and turn head when on stomach, step automatically when in supported stand
1-2 Months Lift head while on stomach to 45 degrees, hold head briefly in middle of body in supported sitting, purposefully move arms and legs
3-5 Months Increase range of motion in neck, trunk, and arms/legs, bring hands to knees and feet, push with legs lifting bottom off of floor when lying on back, roll to side, push up on extended arms when on stomach, make swimming motions onstomach
6 Months Roll to side and stomach from back, push from stomach to hands and knees, attempt to move across floor on stomach (soldier crawl), sit alone with arm support
7-9 Months Transition to hands and knees from a side position, rock back and forth on hands and knees, kneel with support, creep on hands and knees, pull to stand from a supportive surface, cruise along furniture
10-12 Months Sit on small chair or stool, sit up from being in side position, creep up stairs, lower from standing to floor using stable surfaces, begin standing alone, stand from a squat without support, begin walking alone

Achieving gross motor milestones
For some children, the neurological connections to the body are slow or interrupted, and this creates a deficit in gross motor skills. These deficits are usually discovered during a routine checkup, where the pediatrician compares the child’s gross motor progress with standardized guidelines. Some parents notice problems when their child is playing with other children, and they see a difference in balance, coordination or strength. Since not all children develop along the exact same time line, differences noted between children are usually normal and no cause for concern. Some early cautionary signs for a gross motor deficit would be not attempting to roll or trying to sit up by 6 months, not cruising on furniture by 10 months or not walking by 15 months (see Gross Motor Milestones).

Why physical therapy (PT) is important
Deficits in gross motor skills can affect general health by discouraging movement around the home or community in a confident and safe manner. If a child is uncomfortable performing a task (e.g., climbing, swimming, running, hopping), then he loses the strength and skills that would otherwise come naturally in the developmental time line. Less physically confident children may become fearful of their surroundings and begin exploring less, which can limit cognition-increasing experiences and social opportunities that build peer relationships.

PT should start as soon as a deficit is noted. Pediatric PT ranges from birth to 21 years of age and focuses on gross motor strength, coordination and motor planning. During a typical PT session, a child engages in activities designed to address specific deficits. For infants and toddlers, the functional activities in PT help to achieve milestones such as rolling, sitting up alone, cruising along furniture and walking. In older children, standing on one foot, maintaining balance on tiptoes to reach overhead, jumping, hopping, skipping, running, ascending and descending stairs, and catching and throwing a ball are all activities that help in achieving PT goals.

Choosing a physical therapist
To help their child achieve his highest potential in motor function, parents need to make sure the therapist is qualified and experienced. Therapists should have at least a bachelor’s degree and be a licensed physical therapist. Some therapists have advanced training and are certified in specialty areas such as neurodevelopmental techniques, interactive metronome and torticollis.

The therapist’s work place is also an important factor to consider. Therapists can work out of daycare centers, in patient’s homes or in a clinic, and parents need to take note of the atmosphere of the work space. Is it energetic, fun and playful? Is it attractive and appealing to children? Is there plenty of room for the child to move?

The child and his physical therapist should have a comfortable and relaxed relationship. The therapist should spend time building trust, as well as taking an interest in what motivates the child so that activities are more likely to lead to achievement of gross motor goals. The right physical therapist makes a huge difference in a successful outcome.

THERAPY AT HOME

  • Have “tummy time” for infants daily.
  • Use push toys for pre-walking/early walking skills.
  • Jump with both feet onto number or picture squares.
  • Play catch (arms positioned in an L-shape and say “L, L stands for love….Love the ball”).
  • Gallop like a horse (say “step together, step together, like a horsey”).
  • Hop on one foot.
  • Skip (say “Step, hop, switch (legs), step, hop”).
  • Pretend to be a dog or cat when ascending and descending stairs.
  • For single leg balance, pretend to be a flamingo, pop bubbles by kicking them, or kick down blocks.
  • For a heel-to-toe walking pattern you can sing, “Heel toe, heel toe, that’s the way we go.”
  • To learn the movements needed for riding a bike, play “Squash the bugs” where a child pretends to step on bugs while sitting on his bike, using the same action for bicycling with hip and knee flexion into hip and knee extension.

Ryan’s story
Most children experience great improvements with gross motor function when they take PT. Success, however, should be measured by each individual child. When I first met Ryan, he was 14 months behind in stationary skills, 42 months behind in locomotion skills, and 33 months behind in ball skills. He had little awareness of his own body and therefore was not sure how to accomplish certain gross motor skills. As we worked together, Ryan began to trust me. He knew that I would not challenge him past the point of his abilities. We worked on catching a ball only when thrown from five feet away, ambulating on a 4-inch wide balance beam, and ascending and descending stairs with one foot on each step without hand support. We improved balance on uneven and unstable surfaces using a rocker board and standing on one leg at a time. We also performed a lot of deep pressure and strengthening activities for his sensory system which enhanced his joint receptors. We used vibration, wearing a weighted vest, and range of motion of the joint for awareness. There was a focus on his vestibular system as well, to improve equilibrium and balance through his whole body.

By the time he transitioned out of my clinic, he was able to walk up and down stairs, jump forward independently for 23 inches, jump down from an 18-inch surface, transition over obstacles, catch a tennis ball, and hop independently. He gained full gross motor potential in the stationary component, was only 24 months behind in locomotion, and 26 months behind in ball skills. All these accomplishments demonstrated improved motor planning and heightened body awareness. Ryan now plays with his peers at school, and with his younger brother at home. Thanks to early intervention, a caring and qualified therapist, and family support, Ryan experienced a successful outcome.

Angela Johnson, MPT, IMC is a physical therapist at Kid’s Creek Therapy. She has experience working with children with autism, torticollis, Down syndrome, cerebral palsy, CVA, hydrocephalus, and developmental delay. Her certifications include interactive metronome. Angela can be reached at ajohnson@kidscreektherapy.com or 770-888-5221.