Introduction to Paediatric Occupational Therapy
Gross motor skills are fundamental movements that involve large muscle groups and whole-body movements. These skills are crucial for children’s physical development, as they form the foundation for various activities such as walking, running, jumping, and playing sports. For some children, mastering gross motor skills may come easily, while others may require extra support and guidance, especially those with developmental delays or disabilities. Paediatric Occupational Therapy plays a vital role in helping children of all abilities improve their gross motor skills, enabling them to participate fully in daily activities and reach their full potential.
Typical Early Development
At birth, we are bombarded with sensory input. We can do little more than take in and learn to cope with all of the sights, sounds, feelings, tastes and smells in the world around us. This helps us to learn about ourselves and our bodies, and our sensory processing ability forms the basis on which all other development can occur. It takes weeks, or even months, of this for us to learn to move our bodies. It is when this movement begins that we begin to learn that there is more to life than ‘me’. We are designed to learn about our place in the world in stages, or ‘levels’, and this begins with what we experience while on the floor.
While laying on a playmat and, if our mothers are lucky, during some ‘tummy time’, we begin to develop head and neck control and start to push up on our arms. This is how we develop our muscle tone while on the ‘ground level’. When we start to sit, we experience new visual and tactile stimuli, as well as begin to develop balance and postural control, while muscle tone continues to mature. Then we start to crawl, and some more complex skills begin to develop, including bilateral integration, motor planning and midline crossing. And all the while, muscle tone, balance and postural control continue to mature. When we begin to walk, a whole new world of stimuli becomes available for us to experience. All of the above skills appear to become secondary and we learn to multi-task. While the focus may shift to actions carried out with our hands and knowledge learned with our brain, the gross motor skills developed to that point, continue to mature. It is these gross motor and locomotive skills that form a foundation on which other learning can happen. Fine motor skills; visual perceptual and spatial skills; and executive skills are all building blocks in the Wall Model of Development, which can only begin to develop when we have a firm foundation of sensory processing and gross motor skills.
Understanding Gross Motor Skills
Before delving into the role of Occupational Therapy in gross motor skill development, it’s essential to understand what gross motor skills entail. Gross motor skills involve the coordination of large muscle groups to perform activities such as crawling, walking, climbing, kicking, and throwing. These skills develop gradually over time, starting from infancy and continuing through childhood. They are essential for everyday tasks, recreational activities, and overall health and wellbeing.
Muscle tone vs. muscle strength
As adults, when we consider having toned muscles, we may have the picture in our minds of tight abdominals, sculpted biceps or a rippling back. However, these superficial muscles we imagine, while they may be strong, do not necessarily indicate good muscle tone. ‘Muscle strength’ refers to the muscles which contract in order to elicit movements of our arms and legs. These are the muscles that allow us to run, jump, wriggle and jive. They are our ‘moving muscles’ and they can become very strong! ‘Muscle tone’; however, refers to the deeper muscle groups which work together to keep us stable. Two or more muscle groups need to work in equal opposition in order to maintain stability of our joints and of our bodies. These are our ‘stabilising muscles’. Our tummy muscles and back muscles need to work equally, but in opposition, in order to maintain an upright seated posture. Our gluteal muscles need to work equally, but in opposition, to our tummy and leg muscles in order to balance on one leg. The muscles and tendons around our shoulder joints need to work equally, but in opposition, in order to hold on tightly while flying across the monkey bars or moving back and forth on a playground swing set. These are sustained contractions of these muscle groups, rather than the quick contractions and releases required for moving our arms and legs in a dynamic way, and this actually requires a specific type of brain power. When referring to the moving muscles, action elicits activation, and the brain prompts the muscles to begin the movement due to a desired outcome. However, when referring to the stabilising muscles, the brain receives no such prompt, as the activation is required despite INaction. Sometimes, we need a bit of a reminder to kick start the cycle of stability, such as while slumped over a computer or lounging on a couch. Our children may appear to be strong, and they may excel on the sports field. But if they are unable to sit still at a desk for what is considered to be an age-appropriate length of time, they may not have developed sufficient tone of the stabilising muscle groups, and may experience low postural muscle tone. By engaging in developmentally appropriate play activities, such as climbing trees or playground equipment, having wheelbarrow races or handstanding competitions, our children’s brains receive the reminders to activate the stabilising muscles while playing. What better way to become both strong and toned?
Postural control and balance
Postural control and balance skills in children are crucial aspects of their physical development and functional abilities. As children grow and explore their environment, they rely on these skills to maintain stability, move efficiently, and engage in various activities. Postural control refers to the ability to maintain an upright and stable posture, while balance involves controlling the body’s centre of gravity over its base of support. Both are dependent on sufficient muscle tone.
Postural control and balance skills are essential for performing activities of daily living, such as sitting, standing, walking and reaching. They support functional mobility and independence in various environments. Developing strong postural control and balance contributes to overall physical fitness and well-being. Children who have good balance skills are more likely to engage in physical play activities and sports, leading to improved health, muscle strength and coordination. Improving postural control and balance skills helps to reduce the risk of falls and injuries, particularly during activities that require agility and coordination. Children with better balance are less prone to accidents and are better equipped to recover from slips and trips.
Motor planning, bilateral integration and midline crossing
Motor planning, also known as ‘praxis’, refers to the ability to plan and execute purposeful movements in response to a given task or goal. It involves several cognitive processes, including ideation (generating ideas), planning (sequencing movements), and execution (carrying out movements). Motor planning allows children to perform complex motor tasks efficiently and effectively by coordinating muscle actions and anticipating the outcomes of their actions. These skills are essential for activities such as dressing, writing, playing sports, and completing academic tasks.
Bilateral integration refers to the ability to coordinate movements between the two sides of the body, specifically the hands and feet. It involves using both sides of the body, together in a coordinated manner to perform tasks that require symmetry or synchronisation, such as catching a ball. Bilateral integration is important for activities such as crawling, walking, climbing, cutting and drawing, as well as activities that involve crossing the midline of the body. These skills are essential for developing hand dominance, fine motor control, and eye-hand coordination, which are important for academic success and functional independence.
Midline crossing refers to the ability to reach across the imaginary line that divides the body into left and right halves (the midline). It involves crossing one hand or foot over to the opposite side of the body to perform tasks that require coordination and integration of both sides of the body. Midline crossing is important for activities such as reaching for objects, writing, cutting, and tying shoelaces, as well as for promoting the development of hand dominance and bilateral integration. Encouraging activities that involve reaching, grasping, and manipulating objects across the midline helps strengthen connections between the two hemispheres of the brain and promotes the development of eye-hand coordination and visual perception / spatial skills.
Why is Gross Motor play and development so important?
Gross motor play is crucial for child development as it contributes to various aspects of physical, cognitive, social, and emotional growth. Here are a few reasons why gross motor play is essential for child development:
Physical development
Engaging in gross motor activities such as running, jumping, climbing, swinging, and throwing helps develop muscle tone and strength, promoting overall physical fitness and health. Gross motor play enhances coordination and balance as children learn to control their movements and navigate their environment effectively. Activities like crawling, walking, and climbing stairs contribute to the development of fundamental motor skills, laying the foundation for more complex movements and activities.
Cognitive development
Gross motor play involves navigating space and understanding spatial concepts such as distance, direction, and position, promoting spatial awareness and perceptual skills. Engaging in physical challenges and obstacles during play encourages problem-solving skills as children figure out how to overcome obstacles and achieve their goals.
Social development
Gross motor play often involves interaction with peers, promoting cooperation, collaboration, and teamwork as children engage in group activities and games. Physical play provides opportunities for children to communicate with others, express themselves verbally and nonverbally, and develop social skills such as taking turns and sharing. Playing together fosters positive peer relationships, empathy, and social bonding as children learn to respect others’ boundaries, negotiate conflicts, and work towards common goals.
Emotional development
Successfully mastering gross motor skills and overcoming physical challenges boosts children’s self-confidence and self-esteem, fostering a positive sense of self and identity. Engaging in physical play teaches resilience as children learn to cope with setbacks, failures, and frustrations, developing perseverance and determination. Gross motor play provides opportunities for emotional expression and regulation as children release pent-up energy, manage stress, regulate their sensory systems, and experience joy and satisfaction through movement and play.
Overall well-being
Regular participation in gross motor play promotes physical health and well-being by reducing the risk of obesity, improving cardiovascular fitness, and enhancing overall energy levels and stamina. Physical activity has been linked to improved mental health outcomes, including reduced stress, anxiety, and depression, as well as enhanced mood, cognitive function, and overall psychological well-being.
In summary, gross motor play is essential for child development as it promotes physical, cognitive, social, and emotional growth. By providing opportunities for active play and movement, parents, caregivers, and educators can support children’s overall development and well-being, laying the foundation for a healthy and fulfilling life.
Challenges in Gross Motor Skill development
While many children develop gross motor skills naturally through everyday play and exploration, others may face challenges that hinder their progress. Factors such as developmental delays, neurological conditions, muscular dystrophy, cerebral palsy, or injuries can affect a child’s ability to master gross motor skills. Similarly, social anxieties and sensory processing difficulties may hinder a child’s willingness to engage in gross motor play, due to risk aversion or fear, thus hindering their development. These challenges may manifest as difficulties with balance, coordination, strength, endurance, or motor planning, impacting participation in various activities and social interactions. It may also manifest as learning difficulties in the classroom, as they may be restless and fidgety while seated at a desk, or they may not have developed their visual perceptual and/or cognitive skills sufficiently without the fundamental gross motor skills.
The role of Paediatric Occupational Therapy
Paediatric Occupational therapists are trained professionals who specialise in assessing and addressing children’s motor development and functional abilities. They work collaboratively with children, families, and other healthcare professionals to design individualised intervention plans tailored to each child’s specific needs and goals. In the context of gross motor skills, Occupational Therapy interventions focus on:
Assessment
OTs conduct thorough assessments to evaluate a child’s gross motor skills, identifying strengths, challenges, and areas for improvement. They may use standardised tests, observation, and parent/caregiver interviews to gather information about the child’s motor development and functional abilities.
Intervention
Based on the assessment findings, OTs develop customised intervention plans to target specific gross motor skills and address underlying deficits. Interventions may include activities to improve tone, balance, coordination, strength, endurance, motor planning, bilateral integration, and sensory integration. Therapists use a variety of techniques and modalities, such as therapeutic exercise, play-based activities, sensory integration therapy, adaptive equipment, and assistive technology, to help children achieve their goals.
Environmental modifications
OTs collaborate with parents, teachers, and caregivers to create a supportive environment that promotes gross motor skills development. This may involve modifying home, school, or community settings to accommodate the child’s needs and facilitate participation in activities of daily living, leisure, and social interactions.
Education and training
OTs provide education and training to empower parents, caregivers, and teachers with the knowledge and skills to support the child’s gross motor skills development. They offer guidance on incorporating therapeutic activities into daily routines, promoting physical activity and play, and fostering independence and confidence in the child’s abilities.
Progress monitoring and follow-up
OTs monitor the child’s progress regularly and adjust intervention plans as needed to ensure continued improvement and achievement of goals. They collaborate with the child’s healthcare team, school and community resources to provide comprehensive care and support throughout the developmental process.
Benefits of Occupational Therapy for Gross motor skills
Paediatric Occupational Therapy interventions targeting gross motor skills offer numerous benefits for children, including:
- Improved motor coordination, balance, and stability.
- Increased muscle tone, strength, endurance, and flexibility.
- Enhanced motor planning and sequencing abilities.
- Greater independence and confidence in performing daily activities.
- Enhanced social participation and peer interactions.
- Improved visual perceptual skills.
- Better academic performance and classroom participation.
- Reduced risk of injuries and improved overall physical health and well-being.
Conclusion
Gross motor skills are essential for children’s physical development, independence, and participation in daily activities. Paediatric Occupational Therapy plays a crucial role in supporting children of all abilities in developing and mastering these skills. Through comprehensive assessment, individualised intervention, environmental modifications, education, and ongoing support, Occupational Therapists help children overcome challenges and reach their full potential. By promoting gross motor skill development, Occupational Therapy empowers children to thrive and succeed in various aspects of life, laying the foundation for a healthy and fulfilling future.
Links to further information
The following websites and articles are provided for caregivers who would like more information about child development and supporting their child’s gross motor development.
The American Academy of Paediatricians
This website has lots of information about child development and general support for kids, including playful ideas to support gross motor development.
Website: Healthy Children Website
Raising Children’s Network
Raising Children Network is an Australian online parenting portal that provides research-based parenting information on subjects from pregnancy through to adolescence.
Website: Raising Children Network
Child Development Institute
Provides articles and resources on child development and interventions for children with developmental delays.
Website: Child Development Institute
NAEYC
The National Association for the Education of Young Children (NAEYC) website is an online platform for professionals, educators and families providing research, publications and professional development in high quality early education.
Website: National Association for the Education of Young Children
Motor skills intervention research of children with disabilities
The article provides an overview of motor skills intervention research focusing on children with disabilities, highlighting strategies and findings to enhance their motor development.
Bishop, J. C., & Pangelinan, M. (2018). Motor skills intervention research of children with disabilities. Research in Developmental Disabilities, 74, 14–30.
