Integrated Care works with families to provide support to children in the following areas: Gross Motor Development, Fine Motor Development, Motor Planning and Visual Motor Skills. We work on improving and working with muscle tone, strength and development, range of movement, quality of movement, eye-hand coordination, attention to task and sensory integration. Adult caregivers can also benefit from assisting physical therapists.
We look at the quality of a child’s movements such as their pace and gait when they learn to walk, their grasp of toys and crayons, or the pressure they are able to use during play dough play. Our Physical Therapists are concerned with helping children reach their full developmental potential and realizing their full range of motion to improve their quality of life.
Tips for parents from PT:
The following suggestions help to facilitate your child’s development. Children and babies learn through play and interaction with other people such as their caregivers, siblings and peers. They are follow the lead of others around them and repeat those behaviors. They explore their world through touch, sight and sound and learn about the physical properties of the objects that they come in touch with. They use their own abilities through their intrinsic curiosity and exploratory play. They develop all of their senses and their muscles while playing.
Developmental Sequences 1-7 MONTHS:
Change the position of toys and/or mobiles in the baby’s crib so the child will turn their head to see them. Changing the child’s position in the crib also assists with this and gives him/her a different perspective every day. Babies should be given opportunities to lie on their stomach to help develop their trunk muscles and assist them in learning to lift their head.
One way to encourage baby to raise their head is to lay them on your chest and talk/sing to them or, while baby is laying on his/her stomach, shake a rattle above their head to get them to look up. Alternating holding the baby on one shoulder and then the other shoulder will help them learn to turn their necks in different directions to accept visual and auditory stimulation.
As baby develops, it is important for them to begin to place weight on their forearms while lying on their stomach. To help with this, place a rolled towel under his/her arms when he/she is lying on the floor (on his/her stomach). Also, a soft wedge can be used in the same manner with a toy in front of the baby.
You can assist baby with learning to roll from their back to their side or stomach by holding a toy to one side and taking one leg and placing it across the body with the foot flat and the hip and knee bent. Gently rock baby back and forth to help develop the feeling of rolling.
Developmental Sequences 7-10 MONTHS:
It is important to encourage baby to move his/her body. You can help him/her by placing a toy slightly beyond his/her reach so he/she has to pivot and reach to get it. He/She may begin an intentional movement by dragging himself/herself across the floor or by pushing with his/her legs.
Developing trunk muscles are necessary for sitting and we must offer baby many opportunities to sit up. An easy opportunity is when baby is in a high chair. Simply arrange toys on the tray and allow baby to reach for them and manipulate them. If baby is not yet able to support himself/herself, consider using rolled towels placed on either side to make him/her more secure. When you are holding holding baby in your lap in a sit-up position, encourage him to look up, down and around by shaking a toy above and below as well as to the side.
Help your baby keep his/her back straight by tapping or rubbing his/her spine, or bouncing him/her up and down in the sitting position or stroking the center of his/her back gently and rapidly. After your baby becomes stronger and is able to sit-up independently, help him/her learn how to go from sitting to lying by positioning his/her body correctly.
When your baby begins to creep and begins to crawl, encourage him to assume the hand-knee position. Place a rolled blanket below his/her abdomen when lying on the stomach. Once comfortable with this position and baby is able to maintain it himself/herself, rock back him/her and forth. This encourages baby to shift the weight from one arm to the other. This can also be accomplished by placing a toy in front of baby so he/she will pick up one hand to get the toy.
When baby starts to pull to stand on furniture or with assistance, make sure baby’s feet are flat on the floor and knees are apart and slightly bent. Also, always stay close to baby as he/she experiments with standing independently, even if baby is holding on to something. The child cannot sit down from this position without assistance. Spend some time with baby standing in your lap, holding on to his/her hands and bouncing him/her up and down.
Developmental Sequences 11-15 MONTHS:
Around one year of age, baby may start to experiment with standing, without holding an object or a person. This is the first step towards walking. Encourage this type of activity. Hold on to baby’s back and briefly let go while he/she is standing. Also, have baby stand and lean in a corner and hold on to a large toy or provide him/her a ball to throw.
Once baby is standing and holding on to furniture, encourage walking along the furniture. This helps develop the rhythm of walking and along with the muscles needed for walking. Try placing two chairs next to one other and encourage baby to walk between them. Baby will soon begin to gain confidence in his/her abilities. Begin to move the chairs further apart. Baby will let go of one, take a step and grab hold of the next one.
During this time, baby can be encouraged to throw balls overhand, which assists in developing balance while standing. As baby becomes more comfortable with independent standing and taking steps, provide baby with opportunities to stand barefoot on different textures - grass, gravel, sand, etc. Initially, baby will walk between two adults. Encouragement should be provided to walk longer and longer distances in this way. After that accomplishment, provide opportunities to walk up and down small inclines or hills.
When Should a Parent Refer a child to Physical Therapy?
Birth to 2 months:
-Doesn’t lift head in prone position (while lying on their stomach)
-Does not turn head to one side in prone position
-Does not turn head to both sides in supine position (lying on back)
3 Months:
-Does not hold head up 90 degrees in prone (lying on stomach)
-Does not extend both legs or kick reciprocally
-Does not roll to back when placed on their side
4 Months:
-Does not place weight on forearms in prone position
-Does not rotate or extend head
-Is unable to grasp a rattle
-Cannot bring both hands together
5 Months:
-Does not roll over one way
-Does not hold head up when pulled to sitting
-Is unable to hold head steady in supported sitting position
-Does not bear weight on legs
6 Months:
-Is unable to keep head level with body when pulled to a sitting position
-Does not demonstrate balance reactions
-Cannot bear weight on hands in prone position
-Does not move head actively in supported sitting position
7 Months:
-Does not roll over either way
-Does not bear weight on legs
-Cannot lift head or assist when pulled to sitting position
-Demonstrates little balance reactions or protective extension of arms
8 Months:
-Does not roll over both ways
-Cannot sit with little or no support
-Does not hold weight on one hand while in the prone position
-Cannot bear weight on legs and bounce
10 Months:
-Cannot get to sitting position without assistance
-Does not assume crawling position (hand-knee position)
-Does not show interest/motivation to crawl
-Cannot sit on own without hand support
1 year:
-Does not pull to stand using furniture
-Cannot switch positions from sitting to prone
-Does not creep on hands and knees
-Cannot pivot while in sit position to retrieve toy
-Cannot pass an object from one hand to the other
-Cannot stand holding on to someone or something
-Cannot pick up small object
15 Months:
-Does not walk with one hand held
-Cannot stand alone well
-Does not demonstrate balance reaction while in the kneeling position
-Does not walk alone one to two steps
-Does not demonstrate motor planning by climbing on furniture
-Has a hard time picking up small objects
18 Months:
-Does not attempt to creep upstairs
-Does not walk without support
-Cannot throw ball
-Does not bend down to retrieve objects
-Does not demonstrate balance reaction in standing
24 Months:
-Does not run
-Cannot walk upstairs with one hand held
-Cannot carry large toy while walking
-Does not squat in play
-Cannot retrieve toy off of floor from standing position
-Does not climb onto furniture, turn and sit
-Cannot build tower of 6 blocks
-Does not use utensils well
30 Months:
-Does not jump in place with both feet
-Does not stand from sitting by rolling on side
-Cannot catch large ball
-Has difficulty with gait and balance
-Does not walk downstairs using rail for support
-Does not have wide range of movement
-Does not run and stop without holding
-Does not avoid objects when running
36 Months:
-Cannot kick stationary ball
-Is not able to stand on one foot for 2 seconds
-Cannot build tower of 9 blocks
-Cannot complete 5-6 piece puzzle
-Is not using utensils properly
-Does not attempt to ride tricycle
-Does not demonstrate grasp of crayon
Developmental Sequences 16-24 MONTHS:
Adults should always supervise when children are walking, climbing, running, jumping and balancing at this age. Keep in mind that balancing skills are very important to the success of walking, running and climbing. So practice them on a regular basis and challenge your child. Sharpen your child’s skills by gently rocking him/her from side to side while he/she is standing, using an exercise ball during play and/or allowing baby to balance/walk on a wide board or curb. Also, placing things on the floor for the child to step over helps to bear weight on one leg at a time. Assist your child in learning to run by holding hands while running, have baby chase a ball and/or playing chase together.
To help develop muscles, give the child an opportunity to push or pull large toys or boxes around the house. Ride-on toys to pedal and things to climb, including stairs are excellent opportunities to develop muscles, as well. Put on some music for dancing, which is a good activity for children to learn balance, coordination and develop muscles. Play new games asking the child to such as stand on tiptoe, stand on one foot and jump.
Developmental Sequences 24-36 MONTHS:
The child at this age is able to participate in many activities very well. These skills include climbing stairs to slides, peddling on a tricycle, catching large balls, running and standing on tiptoes.
*Caution: Some of these activities are not recommended for babies with Cerebral Palsy. Please check with a physical therapist for appropriate exercises.
The items which help children develop muscles can be found below. Click on the objects for more information.
Baby:
9 months to 3 years
18 months to 5 years
24 months to 36 months
