Foundational

Throughout our journey together, we’ve delved into various aspects of fine motor skills and how we, as Occupational Therapists, can support you in building such complex skills, including Hand-Eye Coordination, Handwriting and Creative Writing for Self- Expression and Wellbeing, Developmental Stages of Handwriting Skills and Fine Motor Skills.

Looking at all the information, we would love to explore what led to our theme this year and all the transitional and foundational skills that highlight success in this area. How perfectly timed! Keep in mind each child’s development journey is unique and non-linear, meaning that each child will develop differently. 

How Do Fine Motor Skills Begin?

As we explored in last month’s blog, all movement patterns, including arm and hand movements, begin with primitive reflexes that are genetically part of a newborn’s structure and makeup. These reflexes allow each infant and child to build upon their skills and develop abilities, such as holding a cup, using two hands to eat, colouring, or catching a ball.

Fine motor skills, which involve arm and hand movements, are not able to be developed until the whole body, from head to toe, starts working together. When this occurs, our postural system (including breathing, ribcage, tummy, and hips) begins to move and activate. With our postural system and our whole body working together, the development of shoulder stabilisation occurs. 

What is Shoulder Stabilisation?

Shoulder stabilisation is the foundational skill for upper body and arm strength. Before a person can learn and perform arm and hand skills, one needs first to learn how to stabilise and hold the shoulder in place for overall control of the arms and hands. Can you guess when this begins? Believe it or not, the foundational skills of shoulder stabilisation kick in just a couple of weeks after birth. When the infant is lying on their belly, either on their parents or on the floor, their elbows and arms are under their shoulders. This is often known as tummy time, and it is used to teach and support the baby to lift their head up against gravity. However, it is not just about that; tummy time encompasses many developmental benefits for the baby, with one of these being shoulder stabilisation.

Shoulder Stabilisation Skill Progression Beginning from 4 to 6 Weeks of Age –

• As the infant grows and strengthens, when lying on their belly, their hands start to sit under their shoulders, pushing from the ground to lift higher. 
• Hands and arms will be under shoulders when lying on tummy; baby will commence pushing up from the ground to lift their head and torso higher.
• Next comes baby being able to prop themselves up on their elbows under their shoulders while on their tummy.
• Then, babies will be able to extend their arms out in front or to the sides, pushing with their hands rather than just their elbows. This leads to some of the critical skills needed for reaching for objects and crawling.

What Does It Mean for Arm Movement and Control?

Arm movements include movement at the elbow, forearm, and wrist to achieve the end product of grasping and fine motor skills of the hand and fingers. Moving your arms in various ways, including forward, backward, up, down, side to side, and turning arms up and down, provides a part of the full functional experience and exploration of the world around us. Depending on the types of movements, such as reaching, different movement patterns and changes occur in these areas of the arms. To have control of these wide ranges of arm movements, shoulder stabilisation is essential to provide appropriate movement for stability or to assist hand placement. Arm movements are activated from the child or person’s interests through their eyes, requiring the initiation of the hand to direct the movement and grasp/manipulate what is of interest. Arm movements are best strengthened with resistance and pressure to enhance one’s awareness of the beginning and end range of movement (bent or extended arm), as well as being able to move the arm in mid-range.

Arm Movement Skill Progression Beginning at 3 to 4 Months of Age –

• Unfisting or unclenching of the hand (from the Palmar Reflex) occurs to pave the way for further arm movement development. Generalised writhing and fidgety movements start primarily from the shoulder and upper arm (uncontrolled movements) due to reflexes discussed last month, and more refined and purposeful movements begin.
• The child begins to bring hands into the midline (at the chest) and can manipulate/play with their fingers.
• The child then progresses to putting their hands in their mouth.
• A child may see an object and try to swipe, move, or grab it with little control, increasing repetition to build out the skill.
• These skills progress into handling an object close to the chest, using two hands to play with it, taking an object with one hand, usually on the same side of the body, and moving it quickly in all directions.
• The progression of reaching, grasping, and moving objects from the same side and across the body to the opposite side (crossing the midline). At this stage, a child has improved their controlled reaching, grasping, moving, and manipulating the object in their hand to large rings or smaller 1-inch cubes.

Over the past few years, during June, we have covered various aspects of Gross Motor Skills, including Core Strength, Muscle Tone, Motor Planning and Coordination and Gross Motor Developmental Milestones. Despite all this, there’s still more to share about this fascinating topic.

Continuing with our theme of transitions, let’s start at the very beginning of movement development, which begins in utero, further develops upon birth, and builds the foundational movement patterns followed by all human beings – Primitive Reflexes!

What are Primitive Reflexes?

Primitive Reflexes are involuntary motor responses that are genetically part of a newborn’s structure and makeup. They form the primary movement patterns on which all our gross and fine motor skill development is based, enabling us to do everything we do today. These foundational movement patterns provide postural support for our daily activities and work in conjunction with sensory systems like the vestibular, proprioceptive, and tactile systems. How cool is that!

What is the Purpose of Primitive Reflexes?

Primitive reflexes provide the human body with foundational movement patterns on which we can base all our gross and fine motor skill development. These patterns are foundational in all movement and postural patterns we engage in daily. 

“At the beginning they are necessary for the nutrition, survival, protection of the new-born, and later in life they are important for the process of learning, communication, emotions, motivation. In typical development, primary reflexes are naturally inhibited in particular order during the first year; they are displaced by substitutional reflexes called postural reflexes. Postural reflexes are more mature models of motor responses that coordinate balance, coordination and senso-motor development.” (Rashikj-canevska, & Mohajlovska, 2020)

Examples of Primitive Reflexes and What Do They Do?

Here are some examples of Primitive Reflexes and a brief overview of their role and appearance. Please note that these are only some of the many primitive reflexes present in our bodies.

The Moro Reflex:

The Moro reflex, also known as the “Startle Reflex,” is observed when a baby’s head suddenly shifts, or if their head falls backward or is startled by a sudden movement, bright light, or loud sound.  The baby will throw their arms away from their body and extend their neck. They may also open their fingers, cry or make no sound. The baby will then quickly bring their arms back together and relax them. 

This reflex is crucial for developing future flexion and extension movement patterns and integrating the adrenal ‘fight or flight’ response to surprises or stress, as well as the connection to the mother in ensuring safety when exploring the world around them through development space and is integrated (no longer present) around six months of age. 

Spinal Galant Reflex:

The Spinal Galant Reflex is an involuntary movement pattern in infants, thought to be crucial during the natural birthing process. Contractions during labour stimulate the lower back, causing hip movement that helps the baby descend the birth canal, which in turn aids in developing the hip movements necessary for crawling and walking. The Spinal Galant is activated by stimuli to the back, such as stroking down one side of the spine while the infant is on their stomach, encouraging hip movement. This can also be done when the child is on all fours. This reflex is also involved in developing the vestibular system and is linked to the Asymmetrical Tonic Neck Reflex (ATNR), which also plays a role in birth. The Spinal Galant Reflex is often associated with urination. Developing in utero around 20 weeks, the Spinal Galant Reflex should be fully developed at birth and is typically integrated between three to nine months of age.

Tonic Labyrinthine Reflex (TLR):

The Tonic Labyrinthine Reflex (TLR) appears in infants when they lie on their stomachs in a pose resembling Superman’s. 

It consists of two types of movements: forward and backward. This reflex is triggered by either bending (forward) or extending (backward) the neck – moving the head up or down. When infants look down (neck flexion), their arms and legs tend to flex or curl towards the body. Equally, when infants look up (neck extension), their arms and legs extend (like Superman!). The TLR is believed to assist infants in adapting to the challenges posed by gravity and affects muscle tone and movement of arms, legs, neck, and trunk. Since head movements activate the TLR, this reflex is closely linked to the Moro Reflex. The integration of this reflex typically occurs around the age of four months.

Asymmetrical Tonic Neck Reflex (ATNR):

The Asymmetrical Tonic Neck Reflex (ATNR) is commonly known as the “fencing reflex” because when a baby lies on their back and turns their head to one side, the arm on that same side will extend, while the opposite arm will flex towards the body – giving the appearance of being ready to fence. The ATNR is activated by a simple head turn to either the right or the left. The kicking sensation felt in the womb is actually due to the ATNR! Additionally, this reflex aids in the birthing process and impacts balance, muscle tone, and hand-eye coordination. This reflex is expected to be integrated around six months of age.