Gross motor skills are large movements such as walking, running and crawling. A child's ability to perform motor skills depends on several things including muscle strength, coordination and flexibility. After a brain injury, brain signals may change. This can affect a child's ability to use their muscles properly. There are several health professionals who can work together to help your child use these muscles better to regain their gross motor skills.

What are gross motor skills?

Gross motor skills are large movements of the body that use large muscles to produce coordinated movements, for example walking, running, sitting, throwing and crawling. Children learn new gross motor skills by practising them until the skill is mastered.

How can gross motor skills be affected after a brain injury?

The effects may be seen in a number of ways, including:

• muscles may become stiff and difficult to move
• movements may be jerky or clumsy and difficult to coordinate
• muscles may become difficult to turn on (paralysis)
• planning and execution of movement becomes difficult (motor planning problems).

A child's ability to perform motor skills depends on several things including muscle strength, coordination and flexibility. Children who have had a brain injury can have long term difficulties with gross motor skills.

What issues may arise for your child?

Your child may need to continue practicing or re-learning gross motor skills in the years after their brain injury. Changes to their control of muscles and movement after a brain injury can cause changes, such as shortening, in soft tissues including muscles. These changes may affect your child's ability to learn or perform gross motor skills in the following ways:

• learning new skills - your child may need more practice than other children to learn new skills
• growth spurts - growth spurts can worsen your child's tendency to have tight muscles. Therefore, it is important to monitor muscle length during growth spurts. Children will be seen regularly in the brain injury clinic to monitor the effects of their growth
• joint pain - if your child changes posture or movement patterns (e.g. if the knee flicks back or hyper-extends, during walking), they may experience pain. Practicing gross motor skills can help your child move in the best and most comfortable way possible for them
• splints/orthoses - splints and orthoses will become too small as your child grows. It is important that your child has regular reviews of the size and suitability of any splints or orthoses.

Treatment

Physiotherapy and occupational therapy

• by teaching motor skills
• by helping to reduce muscle shortening through casts, splints and stretches
• by assessing and treating joint pain
• by reviewing current and recommending new splints or orthoses.

Rehabilitation specialist

• assessing and treating joint pain
• reviewing and recommending splints or orthoses
• using medication to reduce spasticity.

Orthotist

What can you do?

• Monitor your child's muscle length, particularly calf muscles, hamstrings and the muscles around the hip. Ask your physiotherapist to show you how to do this.
• Encourage your child to practice gross motor skills and to perform them to the best of their ability.
• Always follow the routine recommended by your physiotherapist, occupational therapist, rehabilitation specialist and orthotist for any splints or orthoses your child wears.
• Always attend clinic appointments for your child.

Key points to remember

• Gross motor skills are skills that use the large muscles of the body.
• After a brain injury, altered brain signals may affect a child's ability to use their muscles.
• Your child may need to continue practicing or re-learning gross motor skills in the years after their brain injury.

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.