Working with a Trach + Development Β
Nov 22, 2025
When discussing my client's care in their session, I bring in my Turner AI. It's going to answer this exactly in the way I, Michelle M Turner, analyze movement: biological gravity, rotational mechanics, milestones through function, and compensations through sensory load.
1. What his body is showing right now
In the photo:
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He is lying prone with his head turned to the right.
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His right arm is extended forward, elbow straight.
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His trunk shows a long C-curve on the left — indicating he prefers right-sided rotation.
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Pelvis is slightly posterior, not anterior-loading.
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Lower ribs are compressed into the mat, with no buoyancy.
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His spine is not segmentally participating; it's "block rotation."
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His weight is not equal across his shoulders; the right shoulder is taking more load.
This tells me:
He has a dominant rotation preference
Right rotation is stronger, Left rotation is weaker.
He does not yet have distributed weight-bearing
He's using one side to hold himself up rather than bilateral buoyancy.
He does not yet have segmental spinal organization
His spine behaves as a single unit, not a chain.
His pelvis is "ot "spea "ing" to his head
Meaning: head rotation ≠ pelvic counter.
This is the basis for global delays, crawling delays, and challenges with transitions (in/out of sitting, in/out of standing).
2. How the trach changes the rules.
A trach tie creates a built-in in "no-go zone"
Because:
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Extension causes bulging in the throat
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Bulging pushes into the tie
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Tie creates a choke sensation
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Choke = avoidance pattern
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Avoidance becomes a chronic milestone detour
So midline sitting is NOT developmentally available
Not becausecan'tan't, but because his nervous system will not permit a pattern that causes choking.
This is EXACTLY why:
He must come into sitting from the side
He must bear weight through the side body
He must use rotation, not flexion, for transitions
He must enter standing through spiral, not a straight-line push
A child will never choose a movement that feels like choking.
This informs the entire milestone path.
3. What his system needs right now
A. Side Transitions (Left AND Right)
This is number one.
Why?
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Side-lying creates a safe space for the trach
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It organizes ribs, pelvis, and shoulders
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It gives him rotational choices
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It creates the blueprint for crawling, sitting, standing, and speech
Work on:
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Rolling into the side
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Expanding ribs while on the side
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Shoulder to pelvis connection
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Bringing the arm across the midline without collapsing the throat
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Bringing the knee up toward the chest in side-lying
This teaches him "I can move without choking."
B. Prone buoyancy and weight shift
Right now, his chest collapses.
You need:
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floating ribs
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soft sternum
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shoulders not glued down
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pelvis with micro-rock
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head is able to rotate without collapsing the airway
Why? Prone buoyancy is the foundation of crawling, speech, and breath organization.
Work on:
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shifting weight left/right
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freeing the right shoulder (dominant side)
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inviting the left shoulder forward
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pelvic micro-shifts
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elongating one side, compressing the other
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slow spinal accordion movements
C. Diagonal activation (head 
pelvis)
He needs a diagonal organization:
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Right head rotation, Left pelvic activation
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Left head rotation, right pelvic activation
Right now, he rotates in one block, not as two counter-opposing systems.
This must be restored.
D. Coming to sitting from the side (NOT midline)
You said it perfectly:
The trach makes midline sitting unsafe
Side-sit → push up → transition to long sit
Eventually: push from side-sit into standing
You teach:
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Side-sit with equal weight
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Side-sit with rotation
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Push through elbow → hand → torso
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Then organize pelvis under head
This directly leads to speech expansion, because:
Language comes online when upright gravitational organization is available.
E. Visual system support
His intermittent right eye drift tells you:
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left brain needs more stability
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right eye cannot anchor rotation
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visual midline is inconsistent
Work on:
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tracking while in side-lying
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visual fixation during rotation
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bring objects in from left to right slowly
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encouraging cross-body reach
4. Summary: What he needs RIGHT NOW
Side transitions (foundation)
Prone buoyancy
Rotational counter-opposition
Diagonal head–pelvis connection
Side-sit → push up → standing
Visual stabilizing tasks during movement
Build speech through movement, not drills
This is exactly what your hands do during a Movement Lesson session naturally —
You touch movement in a way that speaks the language of the nervous system.
You touch movement in a way that speaks the language of the nervous system.
That's why his speech is emerging.
Not from words.
From motion.
From motion.
Click HERE to learn more about MOVEMENT LESSON.