CLINICAL FOLDER/CARIBOU PAGE 2 Normal gross motor development Normal human motor development follows a general path from crawling, floor sitting, creeping, pull to stand, independent standing and later walking (Woollacott and Shumway-Cook 2011). The development of these motor skills is dependent upon the development of the child’s postural control. Postural control involves ‘controlling the body’s position in space for the dual purposes of stability and orientation’. Quiet standing requires very precise postural control and a high degree of coordination between sensory feedback from sight, balance centers in the inner ear, joint position sensors in joint ligaments, stretch sensors in muscles and pressure sensors under the feet and the motor system comprising the motor nervous system, muscles and joints. To stand up without falling, the child needs to hold their center of gravity over their feet. This is a great feat of balance and requires very precise motor coordination and very sensitive feedback to adjust the child’s posture. It is no wonder that a typically developing child takes 12-13 months to learn this skill. > Rolling Sitting > Crawling > Pull to stand > Standing > Walking Gross motor function classification system (GMFCS) The Gross Motor Function Classification System (GMFCS) for cerebral palsy is based on self-initiated movement, with emphasis on sitting, transfers, and mobility. When defining a five level classification system, the primary criterion has been that the distinctions between levels must be meaningful in daily life. Distinctions are based on functional limitations, the need for hand-held mobility devices (such as walkers, crutches, or canes) or wheeled mobility and, to a much lesser extent, quality of movement. The focus is on determining which level best represents the child’s present abilities and limitations in motor function. Emphasis is on the child’s usual performance in home, school, and community settings. It is therefore important to classify on ordinary performance (not best capacity), and not to include judgments about prognosis. Remember the purpose is to classify a child’s present gross motor function, not to judge quality of movement or potential for improvement. The descriptions of the 5 levels which appear below are broad and are not intended to describe all aspects of the function of individual children. The title for each level represents the highest level of mobility that a child is expected to achieve between 6-12 years of age. An effort has been made to emphasize children’s function rather than their limitations. Thus as a general principle, the gross motor function of children who are able to perform the functions described in any particular level will probably be classified at or above that level; in contrast the gross motor functions of children who cannot perform the functions of a particular level will likely be classified below that level.
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