Six Exercises to build your child’s motor and postural skills

 Do use Don’t use
Domain : Cerebral Function , Postural control ( stability ) and motor coordination ( mobility ) Domain : For children with known neurological or neuromotor problems ; e.g. CP
Age : 5 -15 years Age: Below 5 years and above 15 years

 

  • It takes 15 to 20 minutes

 

Prerequisites
Ensure Comprehension : Child should understand instruction  with minimum verbal or physical prompts
Room: Adequate space , Quiet
Equipment : Stopwatch , Mat or Blanket , Two chair ( one child – sized )

 

  • Repeat 6 times oneexercise if, the goal is only one exercise.
  • Do one time only when the child going to perform all 6 exercise sequentially.

1. SLOW MOVEMENTS

This test involves slow controlled, simultaneous movements of the arms in a seated position. Control of slow, smooth movements is a reflection of cerebellar function.

  • Demonstration :

Examiner is

  • Seated
  • Facing Child
  • Shoulder Abducted
  • Elbow Flexed
  • Hands on shoulder

Slowly extend elbows until arms are stretched out to the side. Move slowly (taking 6 seconds), smoothly and symmetrically. Return at same speed to the start position.

  • AIM
Symmetry Symmetrical
Quality of Performance Smooth
Speed 5 or more seconds

2. Rapid Forearm Rotation

Itreflects the functions of cerebellar – Vestibular integrity. Rapid alternation movement of arm is done by lightly slapping the thigh with the palm of the hand, then the back of the hand then the palm , and so on .This is done with each hand alone , and then both hands together.

  • Demonstration

Examiner is:

  • Seated
  • Facing child
  • Elbow Flexed to 90 degree , and resting on thigh
  • The demonstration should be at moderate speed , and the child should not try to do it as fast as possible , but should make full contact rotation .
  • AIM
R L Both
9 or more rotations in 10 seconds 9 or more rotations in 10 seconds 9 or more rotations in 10 seconds

3. Finger Nose Touching

This exercise related with  cerebellar coordination . It involves touching the nose and then the finger of the other hand , which is extended as far as possible away from the face. After 10 seconds of touching nose and then  the extended finger, the eye are closed and the action is continued. Use of stopwatch is recommended.

  • Demonstration :

Examiner is:

  • Seated
  • Facing child
  • Right shoulder flexed to 90 Degree
  • Arm supinated
  • Index finger pointing to ceiling
  • Left arm reaches out to touch index finger of the right hand with the index finger of the left hand . Then the left index finger touches the tip of the nose.
  • Sequence 1

Eyes open – left arm extended , right moving , 10 secs

Eyes Closed – left arm extended , right moving , 10 seconds

NOTE: Continuous : no stopping between

  • Sequence 2

Eyes open – right arm extended , left moving , 10 secs

Eye closed – right arm extended , left moving , 10 secs

NOTE: Continuous ; no stopping between

  • AIM
Smooth, Direct movements of moving armand extended  arm steady with no  elbow flexion and lightly touches nose and finger tip( may miss once on either nose or finger )
Moving Arm Smooth , direct
Extended Arm Completely extended
Force of Touch Light Touch
Missed contact 0 – 1 miss nose or finger ( can allow)

 

4. Prone Extension Posture

The exercise develops the ability to assume and maintain an arched back position against gravity while prone on floor on the floor.

Demonstration :

Examination lies in prone position on the floor where child can see the movement of the head and limbs of the floor. Simultaneously lift head, arms , chest and thighs off of the floor . Hold for 5 secs as a demonstration. Elbow should be bent so that hands are parallel with the two sides of the head , but knees must be straight.

  • AIM

Duration : 30 Secs

 

Quality
a. Assumes All body parts simultaneously
b. Head Face raised forward , neck extended > 45 degree
c. Upper trunk Definite arch, elbow and shoulders even
d. Thighs Clearly off midthigh distally
e. Knees Flexion < 45 Degree
f. Maintains (based on first 15 secs) Maintain and counts

5. Asymmetrical Tonic Neck Reflex (ATNR)

  • Preparing the Child: With the examiner facing the child, the child assumes a quadrupedal position with shoulders and hips flexed to 90 degree, weight evenly distributed. Knees are shoulder –width apart, shoulder not rotated, elbow extended, with neck neither flexed ( that is , at 0 degree). The child’s eye should be facing the mat.
  • Instruction :

“Keep your arms straight, but not  Locked ”

The examiner gently rotates the head laterally to the right until the chin in in line with the shoulders , and hold for 5 secs.The head is slowly rotated back to midline and the examiner pauses briefly, and does the next rotation in the sequence .The Sequence is in the following orders.

Right

Left

Left

Right

Right

Left

Left

Right

  • AIM

 

Keep elbow flexion from 0 to 30 degree in any rotation of head

6. Supine Flexion

The exercise develops the ability to assume and   maintain flexion against gravity while in the supine position. Demonstration:

  • Lies supine on the floor
  • Arms crossed over the chest and ankles crossed.
  • Instructions: Now I’m going to be a “ super ball”. See how I bring my head and knees together at the same time? Then I hold it as long as I can. Now you try it.
  • AIM

Duration : 30 secs

Quality
a. Assumes All body parts simultaneously
b. Head Chin tucked, neck flexed > 45 degree
c. Upper trunk Definite trunk flexion
d. Hips Flexed >90 Degree
e. Knees Flexion > 90 Degree

 

f. Maintains ( based on first 15 secs) Maintain and counts

If you have any question, please feel free ask us.

Dr. Prasun Kumar Nayak

BOT – NIOH, Senior Occupational Therapist

Bengal Therapeutic Intervention Private Limited, Dumdum

 

Dr. Amit Choudhury

BOT, MOT – NIOH, Occupational Therapist

Singapore

 

Reference:

  1. Brenda N. Wilson, Nancy Pollock .2000. Clinical Observations of Motor and Postural Skills. Second Edition
  2. Fisher, A.G., Murray, E .A, E.A Bundy , A.C 1991. Sensory Integration: theory and practice.
  3. Gilman, S. ( Ed. ) .2000 . Clinical Examination of the Nervous System. New York: McGraw Hill.
  4. Dunn, W 1981, a guide to testing clinical observation in kindergartens. Rockville, MD: American Journal of Occupational Therapy.
  5. Landgren, M., Kjellman, B., &Gillberg, C 1998. Attention deficit disorder with developmental coordination disorder. Archives of Didease in Childhood.
  6. Jones, C., & Monkhouse, MA. 1981. Balcones sensory integration screening. Protocol manual. Austin : Texas Occupational Therapy Association, Inc
  7. Law, M., & Letts, 1989. A critical review of scales of activities of daily living .The American Journal of occupational therapy ,43 , 522-528
  8. Wilson, B. N. , Pollock. N Kaplan B.J Law M. Farris P. 199. Reliability and construct validity of the Clinical Observation of Motor and Postural skills. The American Journal of occupational therapy. 46, 775-783.
  9. Wilson, B.N., Pollock, N Kaplan B.J., & Law M 1994 . Clinical Observation of motor and postural skills skills. Tucson, AZ: Therapy Skill Builders.

2 Comments

  • Pradip Posted January 19, 2018 5:16 am

    It’s good for children…

  • Piya Posted January 19, 2018 9:06 am

    It’s better service for child

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