The purpose of a task oriented/constraints led assessment
Standardized assessments, such as the AIMS, provide the therapist with an overview of the infant's abilities, but does not provide an opportunity to assess the factors that are influencing the infant's motor development and how the task and environment can be adapted to elicit a wider range of motor behaviors.
A task oriented/constraints led assessment starts with observing the infant's motor behavior in different circumstance and environments, and then adapts these to find ways to enhance and expand the infant's available movement repertoire.
Typically developing (TD) infants at the age of 3-6 months will usually spend most of their awake time either being held, carried or supported in sitting by a caregiver, sitting in a reclined seat or lying in supine and hopefully short periods of time in prone. When infants are awake and alert they will usually take notice of the visual and auditory events in their environments, interact socially with parents/care givers and other family members, and spend time exploring their immediate environment using their hands and feet.
Over this period infants will learn to roll from supine to prone, start being mobile in prone , using commando crawling to move about and start pushing up into the hands and knees position and starting to crawl.
Each of these circumstance contribute to the infant's sensorimotor experience, provide opportunities for practicing new motor abilities and evoke movement behavior that is becoming more intentional and goal directed. Their motor patterns are becoming more variable, exploratory and adapted to the environments they encounters.
Infants with developmental delay may be less active, less motivated and less able to interact with their physical and social environments. Factors associated with brain development and neuromuscular development (muscle strength and tone) will impact on their ability to use movement as a means to engage with their social and physical environment.
It is therefore critical to start by identifying the infant's abilities and interests and then to create an environment that allows the infant to start their available movement repertoire to explore and engage with engage with the social and physical environment.
For these reasons the best place to start your assessment is with the infant sitting with support on the caregiver's lap, then move on to observation in supine followed by adaptations to the support surface to see what can be done to increase or enhance the infant's movement and exploratory behavior.
Assessment in sitting and prone follows. Manual assessment of muscle tone and ROM can be done as appropriate during the assessment, or left to the end.
Observation sitting on care giver's lap
Observation of the infant sitting on a caregiver's lap provides important information about their level of awareness of the environment, and their postural and movement abilities.
It also provides an opportunity for the therapist to interact socially with the infant and gauge their level of alertness, ability to pay attention and social engagement. Assessment of the infant's response to visual and auditory events can also be done at this time.
This period of observation also provides an opportunity to listen to the parents' concerns, as well as their understanding and interpretation of their infant's abilities.
At the same time you can provide parents with positive feedback about the infant's abilities and strengths. Parent's are often good at noticing the things their infants cannot do - but less able to recognise the small but important abilities that are important for learning new skills, such as curiosity, visual attention, persistence and so on.
Start by observing the way the caregiver holds, supports and interacts with the infant. Note:
- Is the infant alert and interested in what is going on in the environment?
- The amount of support provided by the caregiver. Is the infant challenged to maintain posture in any way?
- The position of the infant's head. Is it turned to one side, does it flop forwards into flexion, or is it extended?
- What is the posture of the trunk and extremities?
- Does the infant use the available support surfaces for additional stability?
- Does the infant use their hands and feet to explore the surrounding their body and surrounding surfaces.
- Does the caregiver interact socially with the infant and does the infant respond? Does the caregiver allow enough time for the infant to respond.
Next interact with the infant
Let the caregiver support the infant on the lap, with the infant's back to the caregiver ie facing away. Encourage the caregiver to provide only as much support as is needed to allow the infant to sit with the head and trunk erect without too much effort.
The therapist sits facing the caregiver-infant pair, a little distance away.
► Observe the infant's head, trunk and extremity posture and movements. Does she move the extremities and use the feet and hands to explore the surface they are in contact with?
► See if you can engage the infant so that she looks at your face in a sustained manner. Use mouth movements and smiles to draw her attention and remember to allow enough time for the infant to respond.
► Next use a brightly colored toy that make a gentle sound to engage her interest. Does she look at the toy? Does she follow the toy if it is moved to the left and right. Does she move her eyes and her head?
You Tube videos of infants sitting on a caregiver's lap.
What do you see in this video?
Here you see an infant in a social interaction with his mother. He responds to his mother's very lively actions, however, it seems that he is having some difficulty keeping up with her. Notice his social signals that the mom is not picking up on.
More about assessment infant at 2 -3 months
A Pathways.org video Typical and atypical development at 2 months
4 Pull-to-sit and sitting assessment