ABNORMAL MOTOR DEVELOPMENT

CONSEQUENCES OF POSTURE DISORDERS IN INFANCY

Unfortunately even if pregnancy and childbirth were both problem free, various intrauterine posture abnormalities can still occur. Asymmetries often develop in the body of the newborn as a result of intrauterine spatial disproportion.

Posture disorders can be caused by, among others:

• placenta praevia
• relative spatial disproportion
• transverse position
• breach position
• umbilical cord protrusion
• short umbilical cord
• long umbilical cord wrapped around the neck
• uterine malformations …

What can an inappropriate intrauterine position cause?

Motion is created by the perfect harmony of the nervous system and the muscles. In an abnormal position, a part of the baby’s body may develop in an oblique posture.

In these cases, although baby’s nervous system functions correctly, it is unable to properly operate the tense, asymmetrical muscles. Symptoms will be more subtle and nuanced than in the case of cerebral hypoxia, but the baby will nevertheless require physiotherapy, as the proper development and maturation of his/her nervous system is still at risk.

Care for babies with this problem is still inadequate. Parents often receive false encouragement like “s/he will outgrow it, s/he was just in a bad position inside”. The FittBaby program can help insecure parents in identifying these problems early on. A face-to-face meeting will then determine what therapy or motor development specialist is needed for full recovery.

Long-term consequences of unresolved posture disorders

The shape of the spine changes during motor development, reaching its final form at age 10, and stabilizing only once growth is completed at the age of 14-18.

Our posture is a dynamic equilibrium in motion, maintained by the constant work of our muscles. Even in a sitting position, we stabilize our body again and again.

Balance of the muscles responsible for posture is necessary for the joints to get into the optimal middle position. If the equilibrium of these muscles is disturbed, the strain on the joints becomes uneven, leading to a sloppy posture.

Prevention of posture problems have to start in infancy! First, adequate space has to be provided for motor development. Laying in a tummy position, creeping and crawling are crucial in developing a normal posture! A Hungarian research confirms that we still do not take this seriously enough. 62% of our preschoolers already have posture problems, and it only gets worse by high school, where 78% of students have orthopedic disorders.

We now know that symmetry deviations in infancy manifest in preschoolers as the beginning of posture defects, which, if untreated, will worsen during the growth spurt of adolescence, causing serious complaints in adulthood.

This figure illustrates some posture defects, the roots of which can be traced back to asymmetries in infancy.  

SLEEP DISTURBANCES

The muscles of a newborn can be exposed to a variety of tensions already within the womb, and they can be strained during birth as well. Due to such tensions and strains, the muscles cannot relax during sleep, so after a brief time the baby wakes up crying or has difficulty falling asleep. If we experience this, we should start exercising our baby as soon as possible with the help of the FittBaby program, choosing the exercises appropriate to his/her age.

All laying and sleeping positions have both advantages and disadvantages. Let’s take a look at them.

Supine position: It is perhaps the best from an orthopedic point of view, as the hips and limbs can move freely. There is always a reason for the position our baby wants to be in, e.g. tight back muscles, blocked, stiff neck muscles.

Side position: This is perhaps the least beneficial position for healthy hip development. However, many parents favor it because of the risk of aspiration, and it is also the easiest for the baby to get into a fetal position from here. If you decide to lay your baby on his/her side, place a rolled-up blanket at his/her back for support. Only use this position if it is clearly the most comfortable for the baby.  

Abdominal (tummy) position: Initially babies raise their buttocks while in a tummy position. This makes breathing easier and puts less burden on their stomach than sleeping with their legs spread and their bellies lowered, which is how older babies sleep. When they wiggle, their intestines are “massaged”, helping to relieve stomach pain. Do not put blankets, pillows or rags in the crib, as they can suffocate your baby! The neck muscles are not yet strong enough, so care must be taken not to let him/her stay laying on his/her face and thus obstruct breathing. It is also important to remember that sleeping on the stomach is not a substitute for placing the alert baby on her tummy, when s/he can raise his/her head and exercise the neck, back and arm muscles!

Whatever you decide, make sure to turn your baby’s head in both directions, or alternate positions. However, many babies choose the right position for themselves and we just have to make sure their breathing is not obstructed!  For complete safety, we can use baby monitors (but we should know what to do in case the alarm goes off). Whether you have such a device or not, always put your baby down to sleep in a ventilated and not over-heated room, and use a slightly firm, rather than soft and sinking mattress.

CONSEQUENCES OF PERSISTING INFANT REFLEXES

A fetus is already moving vigorously inside the womb. Infant reflexes are essential at birth as well as for the newborn to survive. Newborns are born with reflexive motions, which gradually become suppressed by the more developed areas of the brain as the nervous system matures and the muscles develop. Persisting infant reflexes cause a number of problems with motor coordination and behavior, and negatively affect the ability to learn.

In order to understand and aid our baby’s motor development, we should become familiar with the most important groups of reflexes. Reflexes can be divided into three groups. These groups are not isolated, but while a simpler one is active, a more advanced reflex – the one that will eventually replace it – is already beginning to build upon it. I will now introduce these reflex groups, the age at which they should become suppressed, and what might happen in that inhibition doesn’t take place.

1. Primitiv reflexes
2. Bridging reflexes
3. Postural reflexes

1. Primitive reflexes – they help the fetus and the baby to survive.   

Receding Reflex – if the fetus senses danger inside the uterus, s/he contracts, stiffens, and tries to be motionless. It becomes inhibited still inside the womb.

Moro-reflex – in response to an unexpected event e.g. sudden noise or sound, or if the baby loses support of the head, s/he is startled, spreads out the arms and then quickly pulls them in as if hugging. Its function is not entirely clear. Some believe it is because primates cling to their mothers in dangerous situations, embracing the fleeing parent. Others believe that a reflex of functional significance not only helps survival, but also develops a close relationship between the infant and the mother. 

The Moro-reflex becomes suppressed by the age of 2-4 months, slowly being replaced by a conscious fright reaction. If it remains active past its time, it leaves no time for the brain to consciously analyze an unexpected situation. A bright child thus might become hypersensitive or hyperactive, but remain definitely immature in terms of his/her nervous system.

Grasp Reflex – if a baby’s palm is stroked or gently pressed, the fingers – with the exception of the thumb - flex reflexively into a grasp. This already appears inside the womb. After birth, the grasp reflex is gradually transformed into conscious grab-and-release by 4-6 months of age, and develops into a pinching, squeezing motion around the age of 8-9 months.

If the grasp reflex persists, it causes the hands to be clumsy, a bad pencil grip, and inhibits the development of manipulation. The child’s lips will move as s/he tries to write or draw.

Plantar Reflex – all the toes will curl and grasp in response to a gentle pressure below the toe bed of the infant’s foot. It can be triggered from a few weeks to 12 months. It helps the toes to cling to the ground in a standing position.

If it persists after the standing and walking stages, it inhibits the development of proper equilibrium reactions and is responsible for the lack of hopping.

Asymmetrical Tonic Neck Reflex – can be triggered until 6 months of age. If the infant’s head is turned to the side in a supine position, the arm and leg on that side will be extended, while the other arm and leg will be flexed (this is the so-called “fencing position”). This reflex helps the baby familiarize with his/her hands, and is the first step in the development of hand-eye coordination.   

If this reflex is partially preserved, it will make crossing the midline of the body difficult, which is why crawling will be left out from the development sequence. The child will be insecure in his/her balance and unstable in motion. Another symptom is poor handwriting and a weak expression of thoughts in writing.

Galant-reflex – if we stroke the back of a newborn along the spine, s/he will laterally flex toward the stimulated side. If symmetrical, this reflex aids creeping.

However, if it stays active past this stage, the child will be bothered by the waist of a pant, a belt, or the back of a chair, resulting in constant fidgeting when sitting. This reflex is also connected to bladder function, so if it stays active, it will be responsible for delayed potty training and bedwetting at night.

Tonic Labyrinthine Reflex – it affects muscle tone throughout the whole body.

This helps the baby to straighten out of the fetal position. Secure head holding and good balance are essential, the lack of which will result in difficulties judging distances, height and depth.

If the tonic labyrinth reflex does not get suppressed at the proper time, it will impede the functioning of the equilibrium system and the development of the headrest reflexes. If it remains active even longer, it will be responsible for walking on tiptoes.

2.Bridging reflexes – they inhibit primitive reflexes while preparing postural reflexes.

Babinski-reflex – if we stroke the side of baby’s sole, the toes fan out and upward. This aids the transformation of the Plantar reflex. It is an indication of severe nervous system damage if it can still be triggered past 12 month.

Landau-reflex – if we hold a baby by the chest and lift in a horizontal position, s/he will raise his/her head and arch the back. This reflex strengthens the muscles by the spine, and improves posture and vision. It helps inhibit the Tonic Labyrinthine Reflex, and aids the development of motions associated with eye movement.

The persistence of the reflex is responsible for poor posture and awkward balance.

Symmetric Tonic Neck Reflex - its lifespan is relatively short. It helps the baby to get onto his/her hands and knees, and in this position actually “splits” the body to lower and upper parts. The rocking motion helps to bring the reflex under inhibition. During crawling the eye learns to “cross” the midline of the body, because it focuses first on one, and then the other hand, both acting as moving stimuli. This skill will be essential for the child to be able to read without “losing” the words in the middle of the line. A significant percentage of children with reading difficulties skipped the crawling phase in infancy. Crawling is not only an important developmental level in the child’s coordination and mobility, but it is essential, for example, in the development of the child’s spatial vision.

If this reflex persists, babies will crawl and slide on their buttocks with their legs extended, or pull themselves up to a standing position. Later they might be slouched when sitting at their desks, because when the head bends forward, it is followed by the body, and the child will be laying on the desk while writing. They usually dislike ball games and swimming.

Modified Tonic Neck Reflex - if we turn the infant’s head to the side, the arm and leg on that side will be flexed, while the other arm and leg will be extended. This reflex helps to bring the Asymmetrical Tonic Neck Reflex under inhibition.

3.Postural reflexes – residual helping reflexes that make our movements easier.

Support Reflex – in the event of a fall, the arms open in a support position, protecting the head from impact. The forward-downward reflex can be triggered by around the age of four months, while the backward reflex can only be triggered after the age of six months. If we fall to the side, we support ourselves with the hand of that same side.

Amphibian reflex – if in a prone (tummy) position we raise one side of the pelvis, the hip and knee of the same side automatically flexes. This aids proper creeping, and inhibits the Asymmetrical Tonic Neck Reflex and the Tonic Labyrinthine Reflex.

Strauss Reflex – the name of an adult’s flight reaction in which we are also able to evaluate the stimulus. Keeps the Moro-reflex inhibited.

Segmental reverse reflex – helps in rolling over. If the head is turned to the side, the torso and hip can follow.

Cervical headrest reflex tied to eye movements – if we lean our torso to the side, we automatically adjust our head to the information we see.

Cervical headrest reflex tied to balance – if we move our torso in any direction, we are able to hold our head straight even with our eyes closed.

As we can see, primitive infant reflexes are short lived. If they remain active past their given time, it is considered abnormal, because these reflexes maintain tension in the affected muscles.  

Use the BEST program to mobilize the muscles involved. These exercises take into account reflex development, and are based on professional opinions.

If you did not use it in your infant’s first year of life, then the exercises aiding the maturation of the nervous system and inhibiting primitive reflexes (e.g. Reflex Exercises, Ayres, Smart Gymnastics, INPP, Foundation Therapy, etc.) are recommended for preschoolers, who have:

• missed some stages of motor development (had difficulty rolling over or only rolled to one side, didn’t crawl, stood up very fast)
• exaggerated fright reactions
• uncertain mobility
• a bad sense of balance and fall often
• poor posture, poor muscle tone
• uncoordinated movement, have difficulty coordinating two hands /two feet
• difficulty with spatial orientation, mixing up directions
• struggle with attention, have difficulty focusing for longer periods
• difficulties with integration and socialization.