Objective: Standing is a fundamental requirement for a body to be upright and is a precursor to ambulation. During early childhood development standing helps to properly form the hip joints and prevent subluxation and dysplasia. For children without the ability to weight bear independently, professionals often prescribe time in a standing apparatus. Children may also be prescribed an orthotic either just for the foot, the foot and the ankle or the foot, ankle and knee.
Methods: All movement requires an opposition to gravity. Standing requires forces in two directions, opposition to gravity and applied force. These actions work in the understanding of Newtonian laws while also representing a new understanding of how the body maintains an upright position. Interventions aimed to improve standing should first be focused on the pelvis. Pelvic involvement and positioning drive the alignment of other joints above and below. With proper pelvic engagement and positioning, the hips will properly rotate within the socket and the rotation of the femur will guide proper alignment of the knees. If the knees are properly aligned, the tibia and fibula will align over the ankle and the foot will show the applied force driven throughout the legs. Without engagement of the pelvis, interventions for standing remain suboptimal in both creating movement and in therapeutic value.
Results: This study describes the mathematics and functional anatomy of standing. Additionally, the authors address current standard of care methods to generate weight bearing and how the appropriate mathematics can be applied to improve outcomes.
Conclusions: Parents are taught that babies should be standing between 6-9 months with holding on to furniture and by 12 months is standing freely with arms held high for balance. The last milestone is a precursor to true standing. Standing requires active use of the pelvis to drive the applied force through the feet into the ground and to create the rotation through the lower spine that is countered in the upper thorax and cervical vertebrae.
Development of complex movement patterns (e.g. walking) requires the coordination of momentum and acceleration in space with no fixed points of reference. Functional movement builds upon experiences of moving in space from the neonatal period forward. An infant, having no experience with movement in a gravitational field, creates unique system mechanics in relation to gravity while lacking the cognitive ability to willfully transfer might against mass. Constraints during this developmental period either internal or external lead to system shut down or long-term restrictions. The work described here addresses a method of introducing those experiences in order to change the brain and develop these functional system mechanics. Application of gentle external touch is used to guide a client through a rotational movement. Subtle variation is added to increase the complexity of any and all movement. In this method, learning is not accomplished by finding the point of failure or rote repetition. Rather, basic rotational movements are built upon to create the foundations to initiate and enhance interactive movements. The initiation and stimulation of developmental movement patterns creates the firing of neuralpathways. The firing of the pathways sets off downstream chemical cascades that reinforce these movement patterns. Any and all responses to external stimuli will initiate changes in the brain. The movement response to stimuli is to oppose applied forces thus creating acceleration and momentum. The more acceleration within the system, the more adept a body is to move in and out of asymmetrical poses maintaining balance and fluid movement. Changes in movement patterns and system mechanics are outward expressions of underlying changes in the brain.
Harvard University July 2018
The human body, at its peak, moves fluidly in three-dimensional space maintaining a balance and opposition to gravity. During the neonatal period, infants do not present with the ability to produce purposeful actions or demonstrate specific motor functions. The development of complex movements begins in infancy and builds upon the exploration of limb movement, followed by trunk involvement and ultimately whole body movements (e.g. walking). In their early development, newborns require continuous and unique opportunities to experience functional movement that they may not be able to initiate, stimulate or enhance through their own abilities. Failure to establish the body’s relationship to the natural forces of gravity, rotation and counterbalance during this period of time has been shown to lead to significant short-term and long-term developmental delays. The re-thinking of essential movement patterns during the body’s transition from the neonatal period to early development is key to establishing new evaluation techniques for infants.
In this presentation, the author will present a new model of cognitive sequencing for infants to initiate and integrate functional developmental movement patterns that enhances proper motor development, particularly for those at risk for developmental delays.