User:Leah hirst/sandbox

Gross motor skills are the abilities required in order to control the large muscles of the body for walking, running, sitting, crawling, and other activities. These gross movements come from large muscle groups and whole body movement. This is different than fine motor skills which generally refer to the small movements of the hands, wrists, fingers, feet, toes, lips, and tongue. Both types of motor skills usually develop together, because many activities, such as bringing food to the mouth and tasting with the tongue depend on the coordination of gross and fine motor skills. These abilities are usually acquired during infancy and early childhood as part of a child's neurological and muscular development. By the time they reach two years of age, almost all children are able to stand up, walk and run, walk up stairs, etc. These skills are built upon, improved and better controlled throughout early childhood, and can continue in refinement throughout most of the individual's years of development into adulthood. Athletes, for instance, continue to train and improve their skills well into their teens and beyond. However, the aging process eventually overwhelms the benefit of additional training and gross motor skills decline over time.

It is important to note that the skill sequences in motor development described below have been studied extensively and many therapists and teachers now consider the sequences to be prescriptive. With earlier skills in the sequences viewed as prerequisites for teaching later skills. For typical children, however, great variations in the rate and sequence of motor development are considered normal.

Infancy – birth to age one
There are several developments that will generally take place by the first year of life. The infant should be able to sit without support, crawl, pull itself to a standing position and stand unaided. It should also be able to walk with assistance and imitate some adult activities, like rolling a ball.

Gross motor skills, as well as many other activities, require postural control. Infants need to control the head to use their fine motor control to stabilize their gaze and to track moving objects. They also must have strength and balance in their legs to walk.

Newborn infants cannot voluntarily control their posture. Within a few weeks, though, they can hold their heads erect, and soon they can lift their heads while prone. By 2 months of age, babies can sit while supported on a lap or an infant seat, but sitting independently is not accomplished until 6 or 7 months of age. Standing also develops gradually across the first year of life. By about 8 months of age, infants usually learn to pull themselves up and hold on to a chair, and they often can stand alone by about 10 to 12 months of age.

Development of gross motor skills usually begins in a head to toe direction. Infants first learn and develop the strength to lift their heads and shoulders before they can sit up. The simple act of lifting the head is usually followed by head control. Most infants can lift their heads to a 45-degree angle by the age of four to six weeks, and they can lift both their head and chest at an average age of eight weeks. Most infants can turn their heads to both sides within 16 to 20 weeks and lift their heads while lying on their backs within 24 to 28 weeks. By about nine to 10 months, most infants can sit up unassisted for substantial periods of time with both hands free for playing.

Crawling and walking are major developments of strength and coordination that develop in the second half of the first year of life. Beginning at this time, babies are able to pull themselves up on furniture and other stationary objects. As they gain strength and experience, they are able to walk while holding on to an adult with both hands and then later with only one. Unassisted first steps may be taken between the ages of 36 and 64 weeks and many will be competent walkers by the ages of 12 to 18 months.

Toddler – age one to two
There are additional developments that will generally take place between the first and second years of life. The toddler infant should be able to walk alone, both forwards and backwards, pick up toys from the floor without falling, pull and push toys, sit in a chair, walk up and down stairs with assistance and move to music.

During the second year of life, toddlers continue to add strength and stamina which adds to their physical activities. In addition, they gain experience and confidence which leads to additional new gross motor skills. They can run fairly well and negotiate stairs holding on to a banister with one hand and putting both feet on each step before going on to the next one. Most infants this age climb (some very actively) and have a rudimentary ability to kick and throw a ball.

The neural pathways that control the leg alternation component of walking are in place from a very early age, possibly even at birth or before. If it were not for the problem of switching balance from one foot to the other, babies could walk earlier. Tests were performed on crawling and walking babies where slopes were placed in front of the path and the babies had to decide whether or not it was safe. The tests proved that babies who just learned how to walk did not know what they were capable of and often went down slopes that were not safe, whereas experienced walkers knew what they could do. Practice has a big part to do with teaching a child how to walk.

Toddler – age two to pre-school
During the period from age two until school age, the child continues to strengthen and show increased coordination. This development is a function of increasing muscle mass, neurological maturity and experience. In practice, most children in this age group are encouraged to explore their abilities without parent’s constant holding.

Among the abilities that improve in this period are running, jumping, hopping, climbing and balancing on one foot and on tiptoe. Sports activities, such as tricycle and bicycle riding, ball throwing and catching will be learned in this period. At 3 years of age, children enjoy simple movements, such as hopping, jumping, and running back and forth, just for the sheer delight of performing these activities. They will have sufficient upper body strength that they can negotiate the rungs of a jungle gym. They can walk up stairs alternating feet but usually still walk down putting both feet on each step. They have trouble catching because they hold their arms out in front of their bodies no matter what direction the ball comes from. By the time the child enters school, the gross motor skills will let the child participate in all regular functions, including entering and exiting the building and the classroom.

The more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to the child's fingers. In addition, small muscles tire more easily than large ones, and the short, stubby fingers of preschoolers make delicate or complicated tasks more difficult. There is considerable variation in fine motor development among this age group.

Adolescence and adulthood
Gross motor skills usually continue improving during adolescence. The peak of physical performance is before 30, between 18 and 26. Even though athletes keep getting better than their predecessors—running faster, jumping higher, and lifting more weight—the age at which they reach their peak performance has remained virtually the same. After age 30, most functions begin to decline. Older adults move slower than younger adults. This can be moving from one place to another or continually moving. Exercising regularly and maintaining a healthy lifestyle can slow this process. Aging individuals who are active and biologically healthy perform motor skills at a higher level than their less active, less healthy aging counterparts.

Alternative development and parental concerns
Many children with moderate and severe disabilities achieve the typical "motor milestones" at a slower rate, but follow the normal sequences. Other children have more severe or multiple physical disabilities, including cerebral palsy, in which motor development is disorganized as well as delayed. Spasticity, hypotonia, and primitive reflex patterns interfere with experiencing and practicing normal movement, and hinder motor skill development. Such children are often excluded from activities in which they could develop motor skills, because the children do not already perform the motor skills that constitute the activity.

Society’s views towards children with learning and physical disabilities have evolved over time and there is increasing inclusion and acceptance of such children in regular programs. Young children with special health care needs can and should enjoy physical activity as much as any other child. Depending on the child’s diagnosis and health status, such activities may need to be modified by parents, preschool teachers, child care workers, or therapists. Young children who have significant physical or cognitive impairments usually are enrolled in Early Intervention programs where physical activity takes place as part of the routine day. Alternatively, they are in preschool or child care settings where physical movement activities are adapted to their particular disability, if necessary. Health care professionals can encourage families to ask teachers and therapists for help in integrating those activities into daily routines at home. In addition, many young children with special health care needs (depending on the type of disability) can be included in physical activities that are enjoyed by all children in the community, from playground swings and slides to preschool gymnastic and dance classes.

Babies who are born prematurely (less than 32 weeks of gestation) and with a very low birth weight (less than 3 pounds) are at risk for poor developmental outcomes. These birth conditions are associated with significant motor skills impairment that can persist throughout childhood. Perinatal complications in very preterm and VLBW children increase the degree of motor impairment even further. Motor problems were evident in balance skills, ball skills, manual dexterity, and fine and gross motor development. At later stages of development, less robust relations between birth weight, gestational age, and motor scores were obtained. The absence of a clear relation at school age and during adolescence may indicate a decrease in the effect of perinatal factors such as birth weight and gestational age on motor development as age increases.

Some children in elementary schools are receiving help from pediatric occupational therapists when their fine and gross motor skills seem behind relative to their classmates. Twenty-five years ago, pediatric occupational therapists primarily served children with severe disabilities like spina bifida, autism or cerebral palsy. Nowadays, these therapists are just as focused on helping children without obvious disabilities to hold a pencil. In affluent neighborhoods in and around New York, occupational therapists have taken their place next to academic tutors, psychologists, private coaches and personal trainers. The American Occupational Therapy Association, which has 38,000 members, does not know exactly how many children are receiving these services. But parents, pediatricians, educators and early childhood experts agree that plenty of able-bodied children are receiving occupational therapy.