NORMAL DEVELOPMENT

FETAL TO INFANT

by NOURUL IMAN
 NORMAL DEVELOPMENT
Developmental stage in bobath concept:
• Fetal stage
• Motor development in the first year
• First stage (0-3 months)
• Second stage (4-6 months)
• Third stage (7-9 months)
• Fourth stage (10-12 months)
 FETAL STAGE
1. Growth
• General growth
Weeks (Gestational Age) Height, head to pelvis (cm) Body Weight (g)
9-12 5-8 10-45
13-16 9-14 60-200
17-20 15-19 250-450
21-24 20-23 500-800
25-28 24-27 900-1300
29-32 28-30 1400-2100
33-36 31-34 2200-2900
37-38 35-36 3000-3400
 FETAL STAGE
• Development of the lung
• Produce surfactant at 28 weeks (help condition the respiratory muscles) 
diaphragm develop
• Development of the muscle
• Muscle fibers begin to appear at 11 weeks
• Development of the skin
• 5th weeks  the skin is made up 3 layers (dermis, epidermis, subcutaneous)
 The receptors of skin are located in the epidermis and the dermis. Most of
receptors for touch and pain are distributed within the skin
 Development of Sensation and Movement
• Development of sensory organs (vision,
auditory, olfactory)  development of neural
system  active movements  mother feels
the fetus movements
• Sensory systems develop  fetus is able to
respond to the environment, influence to
initiate movement
• Kicking and pushing uterine wall 
development of body concept
 Development of Sensation and Movement
• Cranial nerve develop  esp. trigeminal nerve  activate face
muscle (swallowing, sucking, breathing)
• Sucking the fingers  body scheme and awareness  tactile
experiences and sensations  midline orientation
• Movements  brain has grown
approximately 100 billion nerve
cells with 10 trillion connections
 Development in the Flexed Posture
• Since embryo is devided and formed it is
already neck flexion
• The neck dynamic stability  continue to
develop with physiological flexion after birth
• Emotional stability / psychological stability
• Self-regulation
• Mother’s biological rhythms (physical and
emotional activity as well as mother’s daily
routine)
• Adapt to environment (sound, smell, sense of time;
day and night)
• Counterbalance of extensor activity
• Development of oromotor, oculomotor, and
breathing pattern
 Development in the Flexed Posture
• Size and weight increases (increase
significant at 28 weeks)  bigger
body in small uterus space  has no
choice but to move in flexed posture
 mass flexor pattern  isometric
contraction  coactivation neck and
trunk
• Capital flexion  connection top to
bottom
 Development between the environment
within the mother’s womb and after birth
1. Gravity
2. Different sensory input (light, sound,
temperature, etc)
3. Body scheme
4. Getting base of support
5. Development of the CNS
6. Taking in food (fetus through the umbilical cord  infant through the
mouth)
7. Day and night  self regulation
8. Immature, reflexive movement  present until the infant develops head
control
 Reflexive movement
1. Rooting reflex
2. Gag reflex
3. Suck and swallow reflex
4. Automatic biting reflex
5. Neck righting reaction
6. Moro reflex
7. Primary walking and primary standing

 Dissapears around time that head control is developing

 FIRST STAGE
0 – 3 months
PHYSIOLOGICAL FLEXION

• Development of the vestibular system

• Development oh head movement in midline
• Neck  starting axial rotation
• Eye  monocular to binocular vision
• Body perception development  hand to mouth, hand to hand
1 month
2 months
3 months
Head movement progression

Head moving toward the midline

 Prone on elbow

scapula movement development

Development of binocular vision
 SECOND STAGE
4-6 months
DEVELOPMENT OF SYMMETRICAL MOVEMENT OF EXTENSION WITH ADDUCTION

• Head control development

• Trunk control development
• Development of the arm
• Development of proximal dynamic stability (flexor development)
• Landau reaction (extensor development)
• Eye  visual field wider
• Body perception development  hand to body, hand to leg, hand to feet
Development of proximal dynamic stability

Incomplete  leg moving out of midline Body perception development

 Development of the arm

weight transfer from side to side Protective extension of the arm

Log rolling

• The vestibular system and connective

movement between cervical and
lumbar spine are not yet develop
• None connective movement of leg /
cortical control of foot
• Leg only automatic movement (in
flexion)
• Head first through watching followed
by arm-trunk
• No 3D pelvic movement
• Low neck and trunk proximal tone
Log rolling to segmental rolling
Landau Reaction (maximum extension)

Mass pattern - Extension with adduction

 Quadruped

Distal stability with proximal stability

 Sitting

Sitting with arm support Ankles are in dorsiflexion because an

insufficient activity of the trunk
 THIRD STAGE
7-9 months
DYNAMIC AXIAL ROTATION
PROXIMAL DYNAMIC STABILITY, SELECTIVITY, COMBINATION
3-DIMENSIONAL PELVIC MOVEMENT

• Variety of voluntary movements and as it moves against base of support

• Locomotion : crawling, bear walking
Selective movement of the leg

Development of leg combination movement

 Dynamic axial rotation

Development of axial rotation for transitioning from supine to quadruped

Sitting

Development of dynamic diagonal

mobility and stability
 3D pelvic movement

Mobile distal stability with 3D pelvic movement

Bridging  dev. ankle and toes movements for
maintaining balance with small B.O.S
3D pelvic movement against B.O.S

Development of kneeling and half kneeling

Distal stability
 FOURTH STAGE
10 – 12 months
SELECTIVE MOVEMENT
FREE TO MOVE AND CHANGE IN DIRECTION OF THE ARMS AND LEGS
FREE HAND MOVEMENTS
Selectivity, development of cognition, visual,
body scheme

Stair climbing
Bear standing and walking

Full extension of extremities

squatting

• Requires graded movement of the

legs within adequate axis
• Develops mobile weight bearing on
the ankles and toes in walking
 side cruising to forward cruising

Steps by abduction and addcution of the hip without pelvis movement

 standing

Anterior pelvic tilt – Mass patterns of both arms in High

counter balance guard  to get head to foot connection
(resemble Landau reaction)
walking

• Highlight of achievement for

postural control
• Head in axis with proximal
activation, dynamic pelvis and
leg movements with the feet
• Moves the ankles and toes same
as voluntary control of the hand
THANK YOU