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newborn infant has crawling instinct right from birth, however, mobility is delayed until the bones, joints and ligaments are strong enough to support and actively propel the infant into all corners of their newly found world. Babies will usually be ready to crawl actively at about 9- months.1-7^ Once infants start to crawl, they can thoroughly investigate their previously inaccessible world: exploring every available inch of floor space, and on their journey testing every found morsel in their path to see whether it is food. Crawling is merely an indication that to walk the infant needs
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ABSTRACT
more time to achieve the necessary coordination and a required level of physical development. Movement skills may be gained by categorizing them with developmental hierarchy. At the bottom of the hierarchy are reflexes, which dominate the motor behavior of infants for the first 3 or 4 months after birth. The early locomotor milestones, including rolling over, creeping, crawling, standing, walking with support, and walking independently are at the next level up the hierarchy. At the top level of the hierarchy are specialized movement skills sometimes referred to as ontogenetic
Effects of infant crawling experience on range
of motion
Ali Cimbiz, PhD, PT, Vahdettin Bayazit, PhD.
34
Objective: The purpose of this study was to show the effects of infant crawling experience on shoulder and hip range of motion and trunk flexibility.
Methods: One hundred and twenty children who had attended the Child and Mothers Health Center in Kutahya City of Turkey between 2002 and 2003 were evaluated, and 40 children walking without assistance with normal motor development were divided into 2 groups, crawler group (CG) (N:20) and noncrawler group (NCG) (N:20). The CG children were selected to match with age of the NCG. Shoulder and hip range of motion and trunk flexibility were measured for assessment.
Results: No statistical differences were observed in all physical characteristics and range of movement (ROM) for girls and boys of each group ( p >0.05). The CG girls were statistically found heavier and taller than NCG ( p <0.05). The CG were found to start to walk later
( p <0.05) and used walker devices less often ( p <0.01) than the NCG. All hip ROM values were found statistically higher in NCG than CG ( p <0.05, p <0.01) except hip flexion ( p >0.05) and no statistical differences were found between groups shoulder ROM values ( p >0.05), except NCG left flexion ( p <0.05). The highest hip abduction ROM was measured in NCG boys and highest external rotation was measured in NCG girls. No statistical differences were found in trunk flexion and sit and reach test in both groups.
Conclusions: Crawling is an important developmental exercise for infants to gain joint stabilization especially on the hip joint, and parents should facilitate their infant’s to crawl and maintain suitable environmental conditions.
Neurosciences 2005; Vol. 10 (1): 34-
From the Physical Therapy and Rehabilitation Department (Cimbiz), Health Institution of Higher School and Department of Biology (Bayazit), Faculty of Sciences and Arts, Dumlupinar University, Kutahya, Turkey. Received 7th March 2004. Accepted for publication in final form 5th June 2004. Address correspondence and reprint request to: Dr. Ali Cimbiz, Assistant Professor, Physical Therapy and Rehabilitation Department, Health Institution of Higher School, Dumlupinar University, 43100 Kutahya, Turkey. Tel. +90 535 393 8164. E-mail: alicimbiz@mail.dumlupinar.edu.tr
tools, living environments and motor behaviors. Children who did not crawl before they started to walk are those in which no locomotor strategy was observed prior to independent walking. In this study we defined these as children who, from the sitting position, stood up and walked. The shoulder and hip were chosen for measurement because of their large size, easiness for measurement of range of movement (ROM) and importance in normal motor development. All infants wore non restricting clothing while having their shoulder and hip joints measured. None of the children complained of forced pain with movement. All measurements were performed 3 times and the best one was recorded. A plastic, 41 cm universal goniometer was use to measure the movements of flexion, extension, abduction, internal and external rotation. Children were positioned as for visual estimation tests. The child moved the affected extremity (thumb pointing upwards) actively and than examiner assisted him/her to the end of range of motion. The same examiner made all goniometric measurements. The shoulder flexion angle was formed by aligning the goniometer with the lateral epicondyle of the humerus, the middle of the glenoid fossa, and a vertical line in the coronal plane. The abduction angle was formed by aligning the goniometer with the lateral epicondyle of the humerus, the middle of the posterior glenohumeral joint line, and a vertical line in the sagittal plane. The internal and external rotation angle was formed by aligning the goniometer with the ulna styloid process, the olecranon process of the ulna, and a horizontal line in the transverse plane.^8 To measure the amount of hip flexion and hyperextension, the goniometer pin was placed on the greater trochanter of the femur and the goniometer was aligned vertically along the shaft of the tibia. Measurement was made with the child lying supine and flexing the hip by raising one leg in the air. The child was placed in the prone position to measure the amount of hip hyperextension. For the angle of hip rotation, the knee was flexed to 90°, and the leg was moved internally and externally in the sitting position.^9 Trunk flexion and lateral flexion were measured using a tape, and sit and reach tests were used for assessment of trunk movements. Distance between end of middle finger and the floor was used for measurement of trunk flexion, right and left lateral flexion between standing and flexion position. The sit and reach test is the most common of all the flexibility tests. It measures the flexibility of the lower back and hamstrings and a box 30 cm ( inches) high and a meter rule was used. The child tried to reach a distance while sitting at a sit-and-reach box.10, The SPSS Windows 9.0 statistical program was used for all statistical analyses. Results were presented as mean ± SD. Statistical evaluation of the
(development of an individual) skills because they are not demonstrated by all persons, but are specific to the needs and interests of a particular person.1- Children who did not crawl before they started to walk are those in which no locomotor strategy was observed prior to independent walking. Bottos et al^4 and Robson et al^5 defined these as children who, from the sitting position, stood up and walked. Others define them as children who passed from the rolling phase or from the sitting position to the upright position with support presenting reptilian movements such as with atypical pattern, sliding on the buttocks, and dragging or rolling on the abdomen. These children started walking with support first and then without. 6 For this reason, and perhaps with a desire to see their child reach the walking milestone, parents are placing their infants in childhood walking equipment. In fact, studies indicate that infants who use these devices may actually develop locomotor problems due to the establishment of a faulty walking pattern.^7 No more studied were found about infants who did not crawl before walking. The purpose of this study was to show effects of crawling on shoulder and hip range of motion in infants.
Methods. Inclusion criteria was full-term babies with a known gestational age of 37-42 weeks, male or female, 18-36 months age and walking without assistance. All children had normal motor development, healthy infants and no neurological or orthopedic disorder history. One hundred and twenty accompanied infants who had attended the Village Clinic for Child and Mothers Health in Kutahya city of Turkey between 2002-2003 were evaluated and 40 children walking without assistance and had normal motor development were divided in 2 groups, the crawler group (CG) (N:20) and noncrawler group (NCG) (N:20). The CG children were selected to age match with the NCG children. The parents were initially informed of the objective of the work and of the subsequent accompaniment; the children were only included in the study after obtaining the consent of the parents. After the child had been waiting in the pediatrics room with the minimum amount of external interference possible, the evaluations were conducted by the examiner in a medical consulting-type room in the village clinic. The evaluations were only made when the child presented in good clinical condition and proved cooperative during the exam. Because of unfamiliarity with the examiner, parents helped to maintain correct position when measuring the passive range of motions. Crawling histories were taken by interviewing mothers, and the infant’s files of the Child and Mother’s Health Center. At interview, the mothers also were asked about using the walker or other
Table 1 - Demographic data of the children.
Features
Groups* Number Start to crawl (months)
Start to walk (months)
Age (months)
Height (cm) Weight ( kg) Using walker or other tools (months)
Noncrawler group (NCG) N = 20 Girls 10
11 ± 1. (9-13) 25 ± 7. (18-36) 83.8 ± 9. 11 ± 1. 12 ± 1.
Boys 10
11 ± 1. (9-15) 27.7 ± 7. (18-36) 83.6 ± 7. 11.2 ± 2. 12 ± 1.
Crawler group (CG) N = 20 Girls 10 7.8±1. (5-10) 12.6 ± 1. (11-15) 31.2 ± 6. (18-36) 94.6 ± 9. 13.4 ± 1. 10 ± 1.
Boys 10 7.7±1. (6-10) 12.7 ± 1. (11-15) 28.9 ± 8. (18-36) 90.9 ± 13. 12.6 ± 2 9 ± 1.
p **
NS
<0.
NS
<0. <0. <0.
*No statistical differences within groups (male versus female) (Mann Whitney U test). NS - not significant **to compare the group differences between the NCG and CG groups, data listed as mean ± SD, (Mann Whitney U test).
Table 2 - Range of motion (ROM) of the shoulder.
Shoulder motion
Groups* Right shoulder (degree) Flexion Hyperextension Abduction Internal rotation External rotation Left shoulder (degree) Flexion Hyperextension Abduction Internal rotation External rotation
Noncrawler group (NCG) N = 20 Female
197.5 ± 10. 90.3 ± 13 180 ± 0 93 ± 8. 122 ± 12.
197 ± 8.6† 91.3 ± 14. 180 ± 0 93 ± 8. 120.5 ± 11.
Male
188 ± 5. 88.5 ± 17. 180 ± 0 99.5 ± 8 116.5 ± 16.
187.5 ± 5. 90 ± 16. 180 ± 0 97 ± 11. 116 ± 14.
Crawler group (CG) N = 20 Female
189.5 ± 11. 80.5 ± 24. 180 ± 0 101 ± 14. 123.5 ± 23
189 ± 10. 78 ± 20. 180 ± 0 98.5 ± 12. 119 ± 20.
Male
190.5 ± 10. 87 ± 16. 180 ± 0 101.5 ± 17. 116.5 ± 16.
187.5 ± 8. 89 ± 17. 180 ± 0 98.5 ± 13. 114 ± 13.
p **
NS NS NS NS NS
<0. NS NS NS NS
*No statistical difference within groups except left shoulder flexion (NCG girls versus boys) **to compare the group differences between the NCG and CG groups, data listed as mean ± SD. NS - not significant †NCG girls shoulder passive range of motion statistically higher than NCG and CG boys, p <0.05 (Mann Whitney U test)
Table 3 - Range of motion (ROM) of the hip.
Hip motion
Groups* Right hip (degree) Flexion Hyperextension Abduction Internal rotation External rotation Left hip (degree) Flexion Hyperextension† Abduction Internal rotation‡ External rotation‡‡
Noncrawler group (NCG) N = 20 Female
138.5 ± 2. 54.5 ± 9. 81 ± 11 63 ± 8. 79 ± 11.
139 ± 2. 54 ± 8. 80 ± 9. 65 ± 12. 75.5 ± 11.
Male
131.5 ± 8. 56.5 ± 10. 86.7 ± 20.9†† 65 ± 6. 71.5 ± 9.
132 ± 8. 58 ± 9. 87.2 ± 21.2†† 64 ± 5. 71.5 ± 9.
Crawler group (CG) N = 20 Female
135 ± 8. 39.5 ± 6. 70 ± 12. 60.5 ± 16. 56.6 ± 10.
134 ± 6. 39.5 ± 6. 72 ± 12. 54 ± 11 58 ± 12.
Male
132 ± 7. 44.5 ± 9. 64 ± 9. 51.5 ± 9. 68 ± 16.
131 ± 8. 44.3 ± 10 64.5 ± 8. 54.5 ± 12. 70 ± 15.
p **
NS <0. <0. <0. <0.
NS <0. <0. <0. <0.
*No statistical difference within groups (NCG and CG boys versus girls), data listed as mean ± SD. NS - not significant (Man Whitney U test) **to compare the group differences between the NCG and CG groups. †NCG hip extension higher than CG ( p <0.01) ††NCG boys hip abduction higher than CG girls and boys ( p <0.01) ‡NCG hip internal rotation higher than CG girls and boys except left hip ( p <0.05) ‡‡NCG hip external rotation higher than CG girls ( p <0.05)
Table 4 - Trunk flexibility.
Trunk motion
Groups* Trunk mobility (cm) Flexion Right lateral flexion† Left lateral flexion† Sit and reach
Noncrawler group (NCG) N = 20 Female
35.8 ± 4. 20.7 ± 3. 21.2 ± 2. 24.7 ± 4.
Male
34 ± 6. 20.4 ± 2. 20.4 ± 2. 23.3 ± 3.
Crawler group (CG) N = 20 Female
32.6 ± 9. 17.3 ± 4. 16.1 ± 5. 22.8 ± 3.
Male
35 ± 7. 16.8 ± 4. 16.4 ± 4 23.6 ± 4.
p **
NS <0. <0. NS
*No statistical difference within groups (NCG and CG boys versus girls), data listed as mean ± SD. NS - not significant (Man Whitney U test) **to compare the group differences between the NCG and CG groups. †NCG trunk lateral flexion higher than CG ( p <0.05)
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