Criteria for Crawling Motion Analysis

[Determination of the crawling cycle]

l A crawling cycle begins when the left (or right) upper limb leaves the floor, and ends when the left (or right) upper limb leaves the floor again after the movement of the limbs and trunk is observed.

l Even if the hand (or elbow or forearm) does not completely leave the floor, it is considered to have left the floor if it is not weight-bearing and can be moved.

l If the hand (or elbow or forearm) does not completely leave the floor, it is considered to have reached the floor when it stops moving.

0. Common items regarding coding

　# Since this criterion focuses on supportiveness, the supportiveness of one upper limb (or lower limb) is observed when the contralateral upper limb (or lower limb) is being moved.

　# If the observation cannot be coded due to the angle of the video or other reasons, set the value to "0".

　＃ If there is no appropriate option in the criteria, set the value as "9".

　＃ If it is difficult to judge, or if you are in doubt, assign "0" or "9".

　＃ If a "9" is given, we will reconsider the item or add criteria.

　＃ For shoulder (scapula) and hip (pelvis) movements (position), focus on the ipsilateral height change, not the difference in height between the left and right sides.

I.1. Items related to crawling patterns and use of the upper limbs

I-1. Types of crawling

　0. Cannot be coded

　1. Belly crawling

　2. Crawling on all fours

　3. Mixed

　9. No code

　# When the abdomen and thighs are on the floor, it is defined as "belly crawling". Bear crawling is also included in "crawling on all fours".

　# When belly crawling and crawling on all fours are observed in one cycle, it is considered to be "3".

　# Mermaid crawling is considered "belly crawling" and bunny hopping is considered "crawling on all fours”.

I-2. How to support with the right upper limb (when the left upper limb is brought forward)

　0. Cannot be coded

　1. Hand support

　2. Forearm support

　3. Elbow support

　4. Upper body is not clearly lifted by the upper limb (supporting upper arm is grounded).

　9. No applicable code

　# If the movement of the left upper limb cannot be clearly confirmed, look at the way the right upper limb supports during the support phase of the bilateral upper limb.

　＃ Assume "2" if the forearm is grounded.

　＃ If the support of the right upper limb changes when the left upper limb is moved, select the lower number.

I-3. How to support with the left upper limb (when moving the right upper limb forward)

　0. Cannot be coded

　1. Hand support

　2. Forearm support

　3. Elbow support

　4. Upper body is not clearly lifted by the upper limb (supporting upper arm grounded).

　9. No applicable code

　# If the movement of the right upper limb cannot be clearly confirmed, look at the way the left upper limb supports during the support phase of the bilateral upper limb.

　＃ Assume "2" if the forearm is grounded.

　＃ If the support of the left upper limb changes when the right upper limb is moved, select the lower number.

I-4. How to move the upper limbs

　0. Cannot be coded

　1. Moves forward with left and right upper limbs alternately

　2. Alternately moves left and right upper limbs forward, but uses left and right upper limbs together when moving forward

　3. Moves forward with left and right upper limbs almost simultaneously

　4. Moves forward with the lower limbs and the upper limbs are off the floor or not bearing weight

　9. No applicable code

　# Mainly look for the ability to move the body forward and whether or not the upper limbs are alternating.

　# When the left and right upper limbs are simultaneously moving forward or off the floor, this is considered "3".

　# When the infant moves forward by kicking the lower limbs in the early or unacquired stage of belly crawling, and the position of the upper limbs moves forward as the body moves, it is considered "4".

　# The difference between "3" and "4" is whether the body moves or not when weight is on the upper limb. If there is body movement when weight is on the upper limb, it is assumed to be "3".

I-5 Combination of the upper and lower limb movements

　0. Cannot be coded

　1. Coordinates ipsilateral upper and lower limbs (right upper limb and right lower limb or left upper limb and left lower limb)

　2. Coordinates contralateral upper and lower limbs (right upper limb and left lower limb, or left upper limb and right lower limb)

　3. Moves both upper limbs (or both lower limbs), followed by both lower limbs (or both upper limbs)

　4. No clear combination of upper and lower limbs

　5. Lower limbs are not intentionally moved.

　9. No applicable code

　# "3" corresponds to bunny hopping and "5" corresponds to mermaid crawling.

I-6 Timing of the movement of upper and lower limbs

　0. Cannot be coded

　1. There is a time when both upper and lower limbs are moving at the same time

　2. There is no time when upper and lower limbs are moving at the same time

　8. When item I-5 is "3" or "5”.

　9. No applicable code

II. Items related to head position and movement

II-1. The way the head tilts when the right upper limb is brought forward (supported by the left upper limb)

　0. Cannot be coded

　1. Head is kept almost vertical

　2. Head tilted to the left

　3. Head tilted to the right

　8. Right upper limb movement cannot be confirmed or when I-4 is "3" or "4”.

　9．No applicable code

　# See if head movement is related to weight shift to the left upper limb (compare it to the shoulder line).

　# Code at the maximum head tilt during right upper limb movement.

　# When the vertical position of the head cannot be determined due to the angle of the image, set the value to "0".

　# Set to "0" when the head or upper body is not clearly lifted by the upper limb (rolling movement to the left or right).

II-2. How the head is lifted when the right upper limb reaches the floor

　0. Cannot be coded.

　1. Head is perpendicular to the floor or bent backward

　2. Head is parallel to the floor or bent forward

　3. Between 1 and 2

　8. Right upper limb movement cannot be confirmed or when I-4 is "3" or "4”.

　9. No applicable code

　# When the vertical of the head cannot be determined due to the angle of the image, "0" should be used.

　# When the head or upper body is not clearly lifted by the upper limb (rolling movement to the left or right), set the code to "0".

II-3. The way the head tilts when the left upper limb is brought forward (supported by the right upper limb)

　0. Cannot be coded.

　1. Head is kept almost vertical

　2. Head tilted to the right

　3. Head tilted to the left

　8. Left upper limb movement cannot be confirmed or when I-4 is "3" or "4”.

　9. No applicable code

　# Code at the maximum head tilt while the left upper extremity is moving (compared to the shoulder line).

　# When the vertical of the head cannot be determined due to the angle of the image, code "0".

　# See if the head shift is related to the weight shift to the right upper limb.

　# Assign "0" when the head or upper body is not clearly lifted by the upper limb (rolling movement to the left or right).

II-4. How the head is lifted when the left upper limb reaches the floor

　0. Cannot be coded.

　1. Head is perpendicular to the floor or bent backward

　2. Head is parallel to the floor or bent forward

　3. Between 1 and 2

　8. Movement of left upper limb cannot be confirmed or when I-4 is "3" or "4”.

　9. No applicable code

　# When the vertical position of the head cannot be determined due to the angle of the image, "0" should be used.

　# When the head or upper body is not clearly lifted by the upper limb, set the code to "0" (rolling movement to the left or right).

II-5. Movement of the head when moving the body forward

　0. Cannot be coded.

　1. The position of the head in the forward/backward direction is almost maintained.

　2. Head tilts in the direction of movement on both left and right sides.

　3. Head tilts in the direction of movement on either side.

　9. No code applicable

　# Code at the maximum head tilt while the body is moving.

　# When the vertical position of the head cannot be determined due to the angle of the image, set the code to "0".

　# If the head tilt can be seen when item I-4 is "3", set it to "3".

　# See if the head shift is related to the weight shift to the left upper limb.

　# See if the propulsive force is obtained by flexion of the neck (movement of the head in the direction of nodding) when propelling with the upper limb.

III. Items related to trunk movement

III-1. How the upper trunk tilts when the right upper limb is brought forward (supported by the left upper limb)

　0. Cannot be coded

　1. Right shoulder (scapula) is clearly raised

　2. Almost the same

　3. Right shoulder (scapula) is clearly lowered

　8. Unable to confirm movement of right upper limb or when item I-4 is "3" or "4”.

　9. No applicable code

　# Look at the vertical movement of the shoulder (scapula) in relation to the floor surface, based on the point of grounding just before the right upper limb is brought forward.

　# Code at the maximum upper body tilt while the right upper limb is moving. Judge mainly by the side view angle. Other angles are also acceptable.

III-2. How the upper trunk tilts when the left upper limb is brought forward (supported by the right upper limb)

　0. Cannot be coded

　1. Left shoulder (scapula) is clearly raised

　2. Almost the same

　3. Left shoulder (scapula) is clearly lowered

　8. Left upper limb movement cannot be confirmed, or when items I-4 are "3" or "4”.

　9. No applicable code

　# Look at the vertical movement of the shoulder (scapula) in relation to the floor surface based on the point of grounding just before the left upper limb is brought forward.

　# Code at the maximum upper body tilt while the left upper limb is moving. Judge mainly by the side view angle. Other angles are also acceptable.

III-3. Lower trunk leaning when moving the right lower limb forward (supported by the left lower limb)

　0. Cannot be coded

　1. Right hip (pelvis) is clearly raised

　2. Almost the same

　3. Right hip (pelvis) is clearly lowered

　8. Movement of the right lower limb cannot be confirmed, or when items I-5 are "3" or "5”.

　9. No applicable code

　# Look at the vertical movement of the buttocks (pelvis) in relation to the floor, based on the point of grounding just before the right lower limb is brought forward.

　# Code at the maximum lower body tilt while the right lower limb is moving. Judge mainly by the rear view angle. Other angles are also acceptable.

III-4. Lower trunk leaning when moving the left lower limb forward (supported by the right lower limb)

　0. Cannot be coded

　1. Left hip (pelvis) is clearly raised

　2. Almost the same

　3. Left hip (pelvis) is clearly lowered

　8. Movement of the left lower limb cannot be confirmed, or when items I-5 are "3" or "5”.

　9. No applicable code

　# Look at the vertical movement of the buttocks (pelvis) in relation to the floor, based on the point of grounding just before the left lower limb is brought forward.

　# Code at the maximum lower body tilt while the left lower limb is moving. Judge mainly by the rear view angle. Other angles are also acceptable.

III-5. Extension of the spine

　0. Cannot be coded.

　1. Back is obviously warped

　2. Almost straight back

　3. Back is clearly bent

　9. No code applicable

　# Focus on the back (especially the lumbar region) when all four limbs are grounded. Judge mainly by the side view angle. Other angles are also acceptable.

　# When the back cannot be confirmed due to clothing, etc., or when there is a twist in the trunk and it is not clear, "0" should be given.

　# Do not code by the way the abdomen is lowered, since there are differences depending on the individual body shape.

III-6. Scoliosis when the right lower limb is brought forward (supported by the left lower limb)

　0. Cannot be coded

　1. Obvious leftward convexity of the spine

　2. Obvious rightward convexity of the spine

　3. Spine almost unchanged, but the right side of the pelvis moves in the direction of movement.

　4. No change in spine and pelvis

　8. No movement of the right lower limb can be confirmed, or when items I-5 are "3" or "5”.

　9. No applicable code

　# Observe from the top angle. If it is unable to observe from the top, "0" is assumed.

　# Observe the scoliosis of the spine and horizontal movement of the buttocks (pelvis), based on the point at which the right lower limb is grounded just before it is brought forward.

　# If the scoliosis is initially seen, the scoliosis can be coded as either enhanced or diminished. For example, if the infant has a left convexity scoliosis from the beginning,

the code is “1” for enhanced scoliosis and “2” for diminished scoliosis.

　# Code the point of maximum spinal and pelvic mobility during the movement of the right lower limb.

III-7. Scoliosis when the left lower limb is brought forward (supported by the right lower limb)

　0. Cannot be coded

　1. Obvious rightward convexity of the spine

　2. Obvious leftward convexity of the spine

　3. Spine almost unchanged, but the left side of the pelvis moves in the direction of movement.

　4. No change in spine and pelvis

　8. Movement of the left lower limb cannot be confirmed, or when items I-5 are "3" or "5".

　9. No applicable code

　# Observe from the top angle. If it is unable to observe from the top, "0" is assumed.

　# Observe the scoliosis of the spine and horizontal movement of the buttocks (pelvis), based on the point at which the left lower limb is grounded just before it is brought forward.

　# If the scoliosis is initially seen, the scoliosis can be coded as either enhanced or diminished. For example, if the infant has a right convexity scoliosis from the beginning, the code is “1” for enhanced scoliosis and “2” for diminished scoliosis.

　# Code the point of maximum spinal and pelvic mobility during the movement of the left lower limb.

IV. Items related to the use of the lower limb

IV-1. How to support with the right lower limb (when the left lower limb is brought forward)

　0. Cannot be coded

　1. Supported by the foot

　2. Supported by knee joint

　3. Thigh is grounded.

　4. Lower limb does not touch the ground.

　9. No applicable code

　# If it is supported by the foot, "1" should be used regardless of whether it is the dorsum, toes, or sole of the foot.

　# If the infant is supported by the lower leg, the code is "2".

　# If the weight is not on the lower limb in the case of belly crawling, the score is "4".

　# If the support of the right lower limb is changing, select the lower number.

　# If the movement of the left lower limb cannot be clearly confirmed, examine how the right lower limb supports during the simultaneous support of the lower limbs.

IV-2. How to support with the left lower limb (when the right lower limb is brought forward)

　0. Cannot be coded

　1. Supported by the foot

　2. Supported by knee joint

　3. Thigh is grounded

　4. Lower limb does not touch the ground.

　9. No applicable code

　# If it is supported by the foot, "1" should be used regardless of whether it is the dorsum, toes, or sole of the foot.

　If the infant is supported by the lower leg, the code is "2".

　# In the case of belly crawling, if the weight is not on the lower limb, it is "4".

　# If the support of the left lower limb is changing, select the lower number.

　# If the movement of the right lower limb cannot be clearly confirmed, examine how the left lower limb supports during the simultaneous support of the lower limbs.

IV-3. Knee position when the right lower limb is on the floor

　0. Cannot be coded

　1. Anterior to the hip joint (in the direction of body movement) or directly below the hip joint

　2. Posterior to the hip joint

　3. No intentional movement of the lower limbs

　8. No movement of the right lower limb

　9. No applicable code

　# If the movement of the lower limb is caused by the movement of the trunk, as in mermaid crawling, the code is "3".

IV-4. Knee position when the left lower limb is on the floor

　0. Cannot be coded

　1. Anterior to the hip joint (in the direction of body movement) or directly below the hip joint

　2. Posterior to the hip joint

　3. No intentional movement of the lower limbs

　8. No movement of the left lower limb

　9. No applicable code

　# If the movement of the lower limb is caused by the movement of the trunk, as in mermaid crawling, the code is "3".

IV-5. How to ground the right foot

　0. Cannot be coded

　1. Dorsal surface of foot

　2. Toes

　3. Sole

　4. Foot not grounded

　5. Grounding area varies

　9. No applicable code

　# The medial edge of the foot is included in "3 " (sole of foot).

IV-6. How to ground the left foot

　0. Cannot be coded

　1. Dorsal surface of foot

　2. Toes

　3. Sole

　4. Foot not grounded

　5. Grounding area varies

　9. No applicable code

　# The medial edge of the foot is included in "3 "(sole of foot).