In pediatric physiotherapy we usually differentiate the evaluation of the infant and the evaluation of the child. In relation to the use of hands and their assessment, it is not very clear what a baby is exactly. Let me explain. The neonate, the baby up to 4 months, the baby from 4 to 9 months, and the baby beyond 9 months are clearly different. So different that their assessment, specifically the use of hands, is vastly different. Of course all these stages make a clear difference with a manual function in the child and the evaluation of it. You can see more here about manual function in the child and its evaluation.
It must be taken into account that the 4 months of life represents a very important change since the maturation of the central nervous system allows for the first time a coordinated, intentional and complete movement of the hand to grasp an object of interest. Before 4 months the baby was in automatic time of motor control, the “general movements” were present, as well as the primitive reflexes. The evolution of cortical circuits allows the organization of more stable and efficient motor patterns. This is facilitated by improved central stabilization and visual and cervico-ocular function.
Support function and reach function
One of the keys to evaluating the manual function in babies between 4 and 9 months, especially the manual function in decubitus, is the reach function and the support function. At 4 1/2 months, the baby was able to develop the first contralateral tummy-down pattern. This is a type of asymmetric central stabilization in which a tripod support is created between one elbow, the hip on the same side, and the knee on the contralateral side. This triple support, together with the movement of the weight towards the supporting elbow, allows the contralateral hand to be released to launch it within reach of the object of interest. It is at this moment when we can define a support arm and a reach arm. The support arm is that receives the load and gives the stability that allows the reach arm to go towards the desired object.
The maximum functionality is that the reach arm quickly becomes a support arm and vice versa. This is only possible with an adaptation of the central stabilization by changing the contralateral pattern to the other side.
It is for this reason that the 4-month-old baby must be placed on his stomach and offered things on the sides to see his contralateral organization and the alternation of it in terms of support and reach. At 4 and a half months the objects are offered on the ground and at 5 months in the air, also on the sides.
The correct function of the hand in prone depends on the ability to organize the central stability that the baby has and the ease of converting the supporting hand into reach and vice versa.
That is why a wide experience in prone is so essential not only for the development of manual function as for motor development in general. The recommendation to spend the greatest amount of tummy time to play, together with the stimulation on the sides, constitute two of the best advice that can be offered to parents from a preventive and global pediatric physiotherapy.
You can see here a video with much more about the manual function in the baby
If you want to know more about the manual function in the infant, we have an online course that will allow you to become an expert on this subject. Look it up here
Comments are closed.