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Normal Development of


M Tshabalala
Normal Motor Development
Principles of Development:
• Development is a continuous process from conception
to birth
• Sequences of development is the same in all children
but the rate of development varies
• Development is related to the maturation of the CNS
• Mass movts are replaced by specific individualized
• Dev is in a cephalocaudal direction.
• Certain primitive reflexes must be lost before the
corresponding voluntary movements develop.
Development of Locomotion
• Developmental sequence is from the development of head
control, to mature walking, running and skipping
• Various postions used to assessing developmental
sequences are:
•Ventral suspension
• Prone
• Supine (PTS)
• Sitting & upright
posture/ standing
Development of Locomotion
• Immature: functioning like a younger child or baby, may
be due to MR or physical damage
• Pathological: due to particular paralyses, myopathies or
• Compensatory Patterns: occur in all motor-delayed &
motor-disordered children.
NB: There are many postures and patterns of locomotion
in rolling, creeping, crawling and walking. Normal or
stromger muscles may be overused, balance reactions
exaggerated, child have difficulty adjusting to gravity or
mechanical forces
Development of Locomotion
Posture of the Newborn:
• Predominantly in flexion
• Knees and elbows remain flexed
• Hips tend to abduction,
• Shoulders mildly retracted
NB: Flexion is accentuated in prone by the presence of
Tonic Labyrinthine Reflex (TLR)
Development of Locomotion

Scholars who have contributed to the vast knowledge of

neurological & developmental examination of the newborn
- Albrecht Peiper, Andre Thomas, Madame Saint-Anne
Dargassies and Heinz Prechtl
Development of Locomotion

CNS Evaluation of the Newborn:

• Sensory-motor behaviour starts developing in utero and are
the result of reflex activity
• Predominates baby’s mvts for 3 to 6 months post delivery
• Integrated into secondary reflexes and complex reactions
seen throughout life
• Knowledge of normal reflexes and reactions is vital for
therapists working with children, these enables them to detect
any delay or abnormality in the child’s development.
Development of Locomotion
They are divided into 5 groups
1) Primitive reflexes
2) Spinal reflexes
3) Brainstem reflexes
4) Midbrain reactions
5) Cortical reactions
Reflexes and Reactions
• Appear in fetal development to ± 6 months
• Then become assimilated into more complex movts
• Only reappear in response to extreme stress, effort or CNS
• Provide an early foundation of posture and movements
• Seem to have survival role
Reflexes and Reactions
PRIMITIVE REFLEXES are the following:
• Moro reflex: position baby’ head and trunk at an angle of about 45 0
from the couch OR supported on palm of the hand. Sudden release of the
hand from the head startles the baby who responds by abduction and
extension of the arms through extension.
• Rooting reflex: a touch to the corner of the mouth stimulates the infant to
seek the nipple
• Sucking/ Swallow reflex: stimulus to the hard palate elicits a response of
the tongue moving forwards and triggering off a rhythmic sucking action
• Gag reflex: present throughout life, elicited by touch to the soft palate
and prevents fluid and food from being aspirated.
• Grasp reflex: elicited by placing a finger into the child’s ulnar side. The
child’s fingers will flex and grip the examiners’ finger. Disappear in 2-3
Primitive Reflexes (continued..)
• Placing reaction: elicited by bringing the anterior aspect of the tibia or
ulnar against the edge of a table. Response is the child lifting up the leg to
step onto OR elevates the hand onto the table.
• Stepping/ Walking reflex: holding the baby upright on the table so that
the sole of the foot presses on it, will initiate reciprocal flexion and
extension of the legs simulating walking. Disappear by 5-6 weeks
• Startle reflex: a sudden noise or tapping the sternum, elicit a similar
response to the Moro but elbows remain flexed and hands closed.
• Plantar grasp reflex: elicited by gently stimulating the sole of the food
behind the toes. Toes will flex
Spinal Level Reflexes
• Are phasic or movt reflexes which co-ordinate muscles of
extremities in patterns of either total flexion or total extension.
• May be present in normal child from birth to 2 mo
• Positive reactions beyond 2 mo indicate delayed maturation
of the CNS
• Negative rxn are normal
• Complete domination by these spinal reflexes result in apedal
Spinal Level Reflexes

• Flexor withdrawal rxn: supine, legs extended, stimulate sole

of the foot Positive rxn: child flex whole leg
Negative rxn: leg remain in extension
• Extensor Thrust rxn: supine, one leg flexed, the other
extended, stimulation of the flexed foot
Positive rxn: extension of the leg
Negative rxn: controlled maintaining of the leg
in flexion
• Crossed extension rxn: supine, one leg flexed the other
extended. Stimulated by flexing the extended leg.
Positive rxn: on flexion of the ext. leg, the opposite or
initially flexed leg will extend
Brianstem Level Reflexes
THEY ARE: Static postural reflexes that effect changes in the
distribution of muscle tone throughout the body
• Respond to a change in position of the head and body in
space (labyringths stimulation)
• Also respond to the change in postion of the head in relation
to the body (stimulation of proprioceptors of the neck)
• Positive OR negative rxns to brainstem reflex testing may be
present from birth to 4 – 6 mo of life
• Positive rxns beyond 6 mo indicate delayed CNS maturation
• Negative rxn after 6 mo are normal. Complete domination of
these relfexes result in an apedal creature
Brianstem Level Reflexes
• Tonic Labyrinthine Reflex (TLR):
1) Child positioned in supine, extremities extended, stimulated by moving
the child to an upright position/ lowering back OR passively flexing the
Positive rxn: extensor tone dominates, arms drawn up in flexion above
level of the head
Negative rxn: no increase in extensor tone
2) Child in prone:
Positive rxn: unable to lift head up, retract shoulders, and extend the
trunk, falls on his face when place into the kneeling position
NB: Normal up to 4 months
Brianstem Level Reflexes
• Symmetrical Tonic Neck Reflex (STNR):
1) Child positioned in quadruped OR over the examiners knees, stimulate
by flexing the head passively:
Positive rxn: arms go into flexion ( UL flexor tone dominates) and the legs
extend (LL extensor tone dominates)
Negative rxn: no change in tone in the arms and legs
2) Child in same position, passively extend his head:
Positive rxn: arms extend (increase in extensor tone), legs flex (increase in
flexor tone)
Negative rxn: No change in tone
NB: Positive rxn normal upto 4 – 6 mo of age
Brianstem Level Reflexes
• Asymmetrical Tonic Neck Reflex (ATNR):
Child in supine, head in neutral position, arms and legs extended. Passively
turn the head to one side:
Positive rxn: extension of the arm and leg on the face side (Increse in
extonsor tone) and flexion of the the arm and leg on the occipital side
(increase in flexor tone
Negative rxn: no change in tone in the arms and legs
NB: Normal from 4 – 6 mo

• Positive Supporting Rxn:

Hold the child in standing, bounce him several times on the sole of his feet
Positive rxn: Increase in extensor tone in the legs with plantarflexion of
the feet. Normal from 3 – 8 months
Mid-brain Level Reflexes
Def: Also known as righting reactions (RR), interact with each other
establish normal head and body relationship in space as well as in
relation to each other.
They are responsible for development of postural control and the ability to
change position in space.
• Labyrinthine Righting Reactions (LRR):
Appear from 1 – 2 mo of age and present throughout life. Enable the baby
to clear airways when in prone lying
• Neck Righting Reaction (NRR):
This makes facilitation using the head as a Keypoint of movement possible
i.e. the body follows the position of the neck. From birth to 6 mo
• Body RR acting on Body: these provide segmental rotation, from 6 to
18 months
Mid-brain Level Reflexes
• Body RR acting on Head:
Enable the child to hold his head in space. When the child is in prone,
pressure on the abdomen and support on arms will aid head extension.
• Optic Righting Reaction:
This is integrated at mid-brain as well as at the cortical level. Starts
appearing from 6 months throughout
• Amphibian reaction:
When child is in prone lying, lifting his pelvis will cause flexion of the arm
and leg on the same sade. Appears from 6 mo and is maintained
throughout life
Cortical Level Reactions
• These reactions are mediated by the efficient interaction of the cortex,
basal ganglia and the cerebellum
• Maturation of the equilibrium rxn brings the individual to the human
bipedal stage of motor development.
• Emerge from 6 mo, consist of postural adjustments of the whole body
• Serve to maintain balance over the existing base when the equilibrium
of the body is disturbed.
• Necessitate rotation, thus are dependent on postural control between
flexion & extension
• They are essentially ERs, develop a stage behind the level reached by
the child.

• Tested in supine, prone, 4pt kn & standing