TIS                         

Developmental milestones that generally appear during four to seven months of age are covered in this chapter. Postural control is beginning and head right reactions through optical, labyrinthine, and Landau reflexes are noted in the milestones listed below.

THE MILESTONES | 4 - 7 MONTHS

• Curious of mirror images
• Able to support weight on lower extremity
• Able to cross the midline and hand objects hand-to-hand
• Can track moving objects with eyes
• Shows a response to emotions of others
• Explores to find hidden objects
• Able to roll prone to supine and supine to prone
• Sits without support
• Able to reach out with one hand
• Interacts in social playing and activities

AREAS OF CONCERN

• Stiffness or appearance of spasticity
• Cannot become content
• Unable to roll
• Dislikes being held or hugged
• Unable to sit independently
• Does not eye track
• Unable to support body weight on legs
• Does not look for sounds or sources of noise
• Does not smile
• Not interested in interactive play with others
• Not babbling or mimicking others

COMPARISON OF PRE-TERM AND FULL-TERM MOTOR DEVELOPMENT

	Full-term	Pre-term
4 months	Sitting with slight support, back straight, head erect	Needs more support in sitting scapular retraction, forward head position, fisting
5 months	Prone on elbows, shoulder- scapula co-contraction, back extension with head upright	Difficult pushing up and maintaining position; minimal back extension with head in line with trunk
6 months	Prone: weight on pelvis, lateral weight shifting during reaching in prone	Prone: weight taken on lower rib cage, minimal head righting
	Supine: sufficient abdominal and LE strength to lift pelvis, activate Abdominals, reach for feet	Supine: no lifting of pelvis, reach for knees, abdominals do not stabilize pelvis
	Rolling with rotation supine to Prone	Emergence of lateral right, may roll hyperextension of back
	Supine: sufficient abdominal and LE strength to lift pelvis, activate Abdominals, reach for feet	Supine: no lifting of pelvis, reach for knees, abdominals do not stabilize pelvis
	Sitting: back straight, arms free, Beginning to shift weight laterally In preparation for transitions	Prop sitting: back rounded, lack of lateral weight shift
	Bears weight in standing with Wide base, grading of flexion And extension	Minimal weight-bearing: often up on toes, stiffening of LE or extremely wide base

Atypical behaviors of the 4 to 5 month-old:

• Lateral weight shifting difficult to free hand for reaching in prone
• Unable to extend arms fully and toward midline in supine
• Kyphotic sitting position
• Unable to sit erect

Atypical behaviors of the 6 to 7 month-old:

• Inability to sit erect without support
• Inability to achieve midline hand position in supine or sitting
• No evidence of lateral or forward propulsion

Treatment interventions should continue to be directed toward the caregiver along a developmental course. Suggestions include: prone lying with encouragement to reach and push-up, sitting on a small bench supported, positioning in a corner chair. Tall kneeling against a mat or to a lowered table, weight shifting on lower extremities, load bearing on the upper extremities.




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