· Now read the Influences on Physical Growth and Health section of our textbook, on pages 295-307 in the 2012 edition, pages 290-300 in the 2016 edition, and pages 285-292 in the 2020 edition. This section continues the discussion on factors that affect physical development, focusing on issues more related to the early childhood years.

Although motor development follows the same organized sequence as physical growth, it does not always follow a fixed maturational timetable. That is because previously learned skills are combined in increasingly complex ways to result in new abilities. Central nervous system development, movement possibilities of the body, the task the child has in mind, and environmental supports all combine to influence the development of motor skills. Having said that, and although the maturational range for the development of motor skills is large, there are general milestones that young children do need to reach, at different stages in their lives, if they are to develop typically.

· Now, please read the Motor Development section of our textbook, on pages 183-189 in the 2012 edition, pages 181-186 in the 2016 edition, and pages 177-183 in the 2020 edition. 

· Next, please read pages 308-314 in the 2012 edition, pages 301-308 in the 2016 edition, and pages 296-303 in the 2020 edition, in order to find out about motor development in the early childhood years. This section looks at the refinement of children’s fine and gross motor skills. There are several good examples of children’s drawings in these sections.

· Now, and in order to see motor development in action and in real children, please take a moment to watch this informative video on motor development, from Grand Rapids Community College.

· And in order to see the difference between typical and atypical motor development, in the first six months of life, and the warning signs that one can look for, in babies who may not be developing typically, please take a moment to watch these typical and atypical motor development videos, attwo months (Links to an external site.) ,four months (Links to an external site.) , and six months (Links to an external site.)  of age, from the Pathways.org website.

· Finally, please take a moment to watch the following video, from the Baby Human documentary. It shows some interesting facts about the development of motor skills, and the beautiful interplay between nature and nurture, when it comes to the development of these skills. Here is one more video, from the same documentary.

There are a few more important facts about motor development that we need to cover, before moving on to Lesson 8. These facts will, in fact, help you understand the disorders that we will cover in Lesson 8.

Motor development tends to proceed in a predictable and sequential manner. The basics of this progression involve very important patterns that children will need to acquire and refine, throughout childhood and beyond, if they are to have an intact and fully functioning motor system (Cook, Klein and Chen, 2016). These basic patterns are:

· The cephalo-caudal pattern: motor development proceeds from head to toe. So the child will develop control over his neck muscles, before he develops control over the muscles of arms and then legs;

· The Proximal-distal pattern: motor development tends to proceed from the spine to the outer body. So, the child will develop control over her arms, before she develops control over her hands and then fingers;

· The mass to specific pattern: the movements of babies tend to be undifferentiated, that is, they tend to involve the entire body. The movements of older children and adults tend to involve specific parts of the body. Which body parts will be involved, in each action, will depend on the action itself;

· The gross motor to fine motor pattern: as we saw in our textbook and other readings, large muscles tend to develop before small muscles;

· The maximum to minimum muscle involvement pattern: when younger babies move, many of their muscles tend to be involved in their movements. As they get older, and muscle and motor development get refined, fewer muscles are used and therefore less energy is spent on a particular task or activity;

· The bilateral to unilaternal pattern: younger children tend to use both sides of the body equally. As they get older, this pattern changes. That is why, as we will see in Lesson 8, a baby using or favoring only one side of her body may be a warning sign of cerebral palsy or some other developmental or neuro-muscular disorder;

· The orderly development pattern: children tend to follow the same sequence of development when it comes to motor skills. The rate may vary, and it does in fact vary, sometimes greatly, between children, but the sequence is usually the same for all children. For example, a child cannot have control over the muscles of his legs if he does not have control over the muscles of his neck. Similarly, a child who is not yet walking cannot run.

Summary

One of the major developmental tasks of the early years involves the urge to move around one’s environment and learn from and interact with it. This urge to move will come in many shapes and sizes, and these include crawling, cruising, walking, running or moving around in a wheelchair or with crutches. Children with disabilities, like typically developing children, will attempt to move around and explore their surroundings in any way they can. Mobility connotes more than just the ability to move. It also involves autonomy and self-determination. That is because if you can move, you can choose where you want to go, who you want to be with and what you are interested in doing.

In this lesson, we have reviewed the typical processes that can influence mobility, such as physical growth, factors affecting physical growth and health, and motor development. Now that we have completed our review of typical physical and motor development, it is time to turn our attention to Lesson 8, where we will learn about the most common physical disabilities that can affect children’s development.

References

· Cook, R. E., Klein, M. D. & Chen, D. (2016). Adapting Early Childhood Curricula for Children with Special Needs (9th Ed.). Boston, MA: Pearson Publishers.

· Liddle, T. L. (2003). Why Motor Skills Matter. Boston, MA: McGraw-Hill.

,

In this lesson, we will learn about important motor impairments that are seen in infants and young children, and we will consider the impact of atypical motor development on other developmental domains.

Learning Objectives

Upon completion of this lesson, you should be able to:

· Describe disorders that affect the structural and neuromotor development of children;

· Explain briefly the causes, symptoms, range of difficulties and other factors involved in disorders such as cerebral palsy, spina bifida and muscular dystrophy;

· Describe ways in which motor impairment can affect development across all domains;

· Be aware of the needs of children with multiple diagnoses;

· Be aware of the needs of children with chronic health conditions.

There are three main types of physical disorders (Cook, Klein & Chen, 2016; Liddle, 2003):

1. Structural abnormalities: Some disorders are the result of physical deformities occurring during fetal development. Examples include spina bifida and limb deformities.

1. Neurological Disorders: With these disorders, there is no obvious physical deformity. Instead, there are symptoms that suggest neurological damage. These symptoms include:

· Abnormal reflex patterns;

· Abnormal muscle tone ( high tone, or spasticity; low tone or flaccidity);

· Delays in the development of postural control;

· Delays in the acquisition of early motor milestones, such as rolling or crawling;

· Poor balance and coordination;

· Abnormal gait;

· Clumsiness when reaching for or manipulating an object.

2. Motor Regression: In these cases, the child’s motor skills and strength deteriorate instead of becoming more sophisticated.

Many neurological disorders do not become evident until months or even years after birth, depending upon the severity of the condition. That is because in the early months after birth, an infant’s early movements are reflexive and are therefore not under voluntary control.

The Central Nervous System (CNS), acts upon the musculoskeletal system to initiate and execute movement. The musculoskeletal system is composed of bones, muscles, and joints, as well as their associated ligaments and tendons. Below are a few useful definitions (Gallahue, Ozmun & Goodway, 2011):

· Bones. The bones of the skeleton form the internal scaffolding of our body. Bone disorders may be congenital or acquired and may involve only one limb or the entire skeleton. Two of the more common extremity deformities seen in infants and children are clubfoot (Links to an external site.)  and developmental dysplasia of the hip (Links to an external site.) . These are complex deformities that involve both bone and soft tissue. There are other bone disorders that cause frequent fractures. These are generally associated with a significant weakness of the bone due to metabolic or inherited factors.

· Joints. These are the point of connection between two or more bones, and they may malfunction in children. Although arthritis is commonly thought of as an adult disease, juvenile rheumatoid arthritis (Links to an external site.)  and related disorders are seen in young children and can have a significant impact on development.

· Muscles. The main function of the muscles is to contract ( shorten) and produce movement across a joint. In order for this to happen, electrical impulses from the brain must pass through the spinal cord to the anterior horn cell, then to the peripheral nerve and to the neuromuscular junction where it synapses with the help of a neurotransmitter. The message then passes to the muscle fiber, causing it to contract, and movement results. A defect anywhere in this chain, known as the neuromuscular system, may lead to weakness. This will be discussed, in greater detail, later in this lesson under the heading of “Motor Regression”.

· Spina Bifida. Please start this section by watching this short video (Links to an external site.)  about Spina Bifida. Spina Bifida (a latin term that means “divided spine”) is one of the most common congenital birth defects associated with a structural abnormality. There has been a recent decline in the incidence of Spina Bifida, in Canada and most of the developed world, due to the dietary supplementation with folic acid during pregnancy. Spina Bifida is one of several neural tube defects that result from failure of the spine to close during fetal development. In order to learn about Spina Bifida, please read the Neural Tube Defects book chapter (available through the Library Course Reserves). This book chapter defines and describes the multifactoral causes and effects of spina bifida and its most common type, meningomyelocele. As you read this article, pay close attention to the associated impairments and medical complications of this disorder. Note that this disorder has many degrees of impairment, depending on when and how much of the brain, spinal cord, and vertebrae are affected. In most cases, Spina Bifida is accompanied by a condition called Hydrocephalus (Links to an external site.) , which results in the build up of fluid inside the brain. A surgical procedure called “shunting” relieves the fluid build up in the brain. Without the shunt, the pressure build up can cause brain damage, seizures and blindness. The shunt can sometimes malfunction and when that happens, the child’s head may get bigger. Other symptoms of shunt malfunction include irritability, vomiting, poor appetite, drowsiness, redness along the shunt tubing line, seizures and headaches (Lutkenhoff, 2008).

Cerebral Palsy

The most common type of neuromotor disorders is Cerebral Palsy. The term “Cerebral Palsy”(CP) does not describe one condition, but rather is a broad category covering a range of conditions. CP is a disorder of posture and movement caused by atypical development of the brain, or damage to the brain before, during, or shortly after birth. In most cases, CP is not progressive, that is, the neurological damage does not become worse over time. However, the manifestations of this damage in terms of the resulting disability can gradually become worse in adult life due to changes in the muscles and joints.

The fact that the term CP refers to a diverse range of motor impairments means that there is a wide-ranging variability in the severity of its expression and its impact on development. Generally it is regarded as a multidimensional disorder because it can be associated with other difficulties as well as problems with motor control. Because the damage involves the brain, the individual can also have problems with cognition, seizures, vision, hearing and behaviour. Before we move on to describe CP in greater detail, please take a moment to watch this informative video about it.

Cerebral palsy is typically described in two ways. These are (1) limbs involved, and, (2) physiological impairment and the nature of the motor interference. In order to learn about more cerebral palsy, how it is classified, and what its impact may be, on the development of the child, please read the An Introduction to Cerebral Palsy book chapter (available through the Library Course Reserves).

Minimal Cerebral Dysfunction

There are many children who experience mild motor difficulties which are probably neurological in origin, but the damage may be too mild to be detected in brain studies, and the children are generally not severely impaired. Although the causes are similar to CP, a diagnosis of CP is not usually given, because the difficulties that are associated with these conditions are much less disabling. Such conditions are generally referred to as Developmental Coordination Disorder (Links to an external site.) . There will be a thorough discussion of this condition in ECED 441. 

Spinal Muscular Atrophy & Muscular Dystrophy

In this section, we will discuss two main disorders:

Spinal Muscular Atrophy (SMA) which is a progressive degenerative disorder of the motor nerve cells in the spinal cord. Symptoms of this disorder include progressive weakness and atrophy of the trunk muscles. Spinal muscular atrophy is a genetic disorder with no known cure. To learn more about this condition, please visit the SMA section (Links to an external site.)  of the Kids Health website.

Muscular Dystrophy:

Muscular dystrophy involves the progressive degeneration of the voluntary muscles (eg. those in the arms and the legs). Muscle cells are gradually replaced by fat and fibrous tissue, producing increasing weakness and difficulties in movement. Early symptoms occur as young as three years of age. Muscular Dystrophy has many types, the most common of which is Duchenne Muscular Dystrophy, which is not only progressive, but also fatal. To learn more about Muscular Dystrophy, please visit the Muscular Dystrophy (Links to an external site.)  section of the Kids Health website.

Previously, we have discussed conditions such as cerebral palsy and spina bifida as single disorders. However, some children have more than one diagnosis, and may exhibit a wide range of characteristics depending on the combination of the disorders that they have. Some medical conditions that can be seen in children with multiple diagnoses include epilepsy and seizures (Links to an external site.) , hearing or vision loss, hydrocephalus, skeletal deformities of the limbs and/or spine, feeding and swallowing difficulties (Links to an external site.) , cognitive impairment (to be covered in Lesson 10), and autism spectrum disorder (to be covered in Lesson 12).

Individuals with severe problems will need ongoing support throughout life. In childhood, the support needed for inclusion in community settings such as daycare and school is typically provided by a multidisciplinary team which includes parents, teachers, early interventionists, physical, occupational and speech therapists.

The number of children with chronic illnesses within early childhood environments is increasing. This is primarily due to medical advances that are not only saving or prolonging these children’s lives but also providing them with the technology that enables them to be mobile, and that makes their integration into a community setting easier. Therefore, in the final section of this lesson, we will recognize these children, and bring your attention to the type of health care supports that they may need, in order to be fully integrated into community settings.

Young children with complex health care needs face many challenges. What differentiates these children from those with multiple disabilities is the fact that they have a medical condition. Many of these children have disabling syndromes while others have conditions like type 1 diabetes (Links to an external site.) , type 2 diabetes (Links to an external site.) , HIV/AIDS (Links to an external site.) , asthma (Links to an external site.)  or cystic fibrosis (Links to an external site.) . Staff working with these children should be aware that many of these conditions are not static, and because of that, changes in the child’s health may require changes in the type of care he/she is given.

As with multiple disabilities, a multidisciplinary team is typically involved in the primary care of these children. Some children with chronic health care conditions use specialized equipment such as wheelchairs or portable ventilators; others may require medication in order to control their condition, or at least lessen its impact. Frequent absences from the community, side effects from medication, pain, fatigue, attention difficulties, and social and emotional difficulties are not uncommon occurrences in the lives of these children, due to the ongoing nature of their medical problems.

If you wish to introduce motor impairments and/or chronic health conditions to children, here are a few books you can use, for this purpose:

· Anderson, M. E. (2000). Taking Cerebral Palsy to School. Saint Louis, MO: JayJo Books.

· Gosselin, K. (1998). Taking Asthma to School. Saint Louis, MO: JayJo Books.

· Gosselin, K. (1998). Taking Cystic Fibrosis to School. Saint Louis, MO: JayJo Books.

· Gosselin, K. (2000). Taking Diabetes to School. Saint Louis, MO: JayJo Books.

· Lears, L. (2005). Nathan’s Wish: a Story About Cerebral Palsy. Morton Grove, IL: Albert Whitman & Company.

· Shaefer, L. M. (2008). Some Kids Use Wheelchairs. Mankato, MN: Capstone Press.

· Shaefer, L. M. (2008). Some Kids Wear Leg Braces. Mankato, MN: Capstone Press.

Summary

Well, we have come to the end of another lesson and what a lot of ground have we covered! We have reviewed many of the common physical/motor disorders in young children and have seen how these disorders affect development and learning. Hopefully, the many websites you have visited and the videos you have watched have given you a deeper understanding of these conditions.

Children with physical/motor disorders may experience difficulties in exploring their environment. They may become overly dependent on adults for their daily needs. As you know, children learn by exploring their environment and by interacting with the physical and social worlds in which they live. When mobility is compromised, and it often is, when it comes to these disorders, learning and development (in all areas) may be compromised as well. For instance, when fine motor development is compromised, simple tasks such as turning the pages of a book or using a paint brush, become compromised. Therefore, the simple joys of the early years may be unavailable or inaccessible to these children. Because of that, some of these children may end up with delays in developmental areas other than the motor domain. This is something we must keep in mind, when working and interacting with these children.

References

· Cook, R. E., Klein, M. D., & Chen, D. (2016). Adapting Early Childhood Curricula for Children with Special Needs (9th Ed.). Boston, MA: Pearson Publishers.

· Gallahue, D., Ozmun, J., & Goodway, J. (2011). Understanding Motor Development: Infants, Children, Adolescents, Adults. New York, NY: McGraw Hill.

· Liddle, T. L. (2003). Why Motor Skills Matter. New York, NY: McGraw Hill.

· Lutkenhoff, M. (2008). Children with Spina Bifida (2nd Ed.). Bethesda, MD: Woodbine House.

Lessons 7 and 8

You work for an infant/child development center and you have been asked to prepare a power point presentation for new parents, which would address the following:

· A review of current research on brain development in infancy and childhood, with a focus on the importance of appropriate stimulation during the first six years of life (3 points)

· At least three ways of supporting infants or children’s early brain development, with a focus on the consequences of either under or over-stimulating babies and children (3 points)

· A list and description of the developmental milestones of early fine and gross motor development in infants, toddlers and young children. Please note that simply including a table that contains these milestones is not enough. You are also not allowed to simply copy and paste a table, from our textbook (3 points)

· A list (and clear description) of possible red flags, for cerebral palsy (3 points)

Your power point presentation should include at least one video (Youtube, Vimeo…), that discusses one of the above-mentioned topics (1 points). Please do  not embed the video(s) into your slides as that sometimes makes it difficult for me to view it/them. Should this happen, there will be a delay in submitting your grade. So instead, please just provide a link to it/them

The power point document needs to be submitted as a PDF document 

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