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פידס > 0-12 Months: Motor Development > Flashcards

0-12 Months: Motor Development Flashcards

1
Q

Full term neonate vs. Preterm

physiological FLEXION

A

full term: physiologic flexion in all positions

flexion caused by utero positioning during last trimester

premature infants lack physiologic flexion

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2
Q

Swaddling

benefits (5)

precautions

A
  1. promote physiological flexion- use with PREMATURE infants
  2. self-CALMING (self regulation) by allowing hand to mouth sucking
  3. increase proprioceptive and kinesthetic stimulation
    - children with lax ligaments do not have good proprioception
  4. increase MIDLINE ORIENTATION
  5. helps infants sleep better in SUPINE
  • AVOID SWADDLING WITH LEGS EXTENDED AND ADDUCTED WHICH CAN CAUSE HIP DISLOCATION
  • -can use the Halo Sleepsac (wearable blanket which is safer)
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3
Q

Where do we need elongation for WB

A

need elongation on the WB side

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4
Q

why do peds need to learn to cross midline

A

NEED FOR SCHOOL

body and space awareness

work on rotation, copy postures, have them make an x, cross, grapevine

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5
Q

NEONATE

first 28 days

A

flexor tone diminishes gradually bc HANDLING and GRAVITY

persistent fisting beyond 3 months: suggests hypertonia, UMN lesion

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6
Q

persistent fisting beyond 3 months

A

RED FLAG
persistent fisting beyond 3 months: suggests hypertonia, UMN lesion

cortical thumb in palm is ok if hand spontaneously opens and no other neurological signs (dont want beyond 7 months)

older children can be DISTAL FIXING because of low tone and weak core–need WB and core strengthening

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7
Q

sign of weak core in children

A

triangle chest

need abs to pull ribs down

children without abdominal strength

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8
Q

NEONATE:
PRONE

  1. posture
  2. hip
  3. UE
  4. hands
  5. where is the weight
  6. what can the neonate do in terms of motion
A
  1. Anterior Tilt
  2. HIP: Flexion and adduction: prevent pelvis from lying flat
  3. UE: flexed and Adducted:
    close to the body. Some cases arms are under body
  4. HANDS fisted secondary to strong grasp reflex

Weight on face and upper chest

Neonate can lift and turn head to either side

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9
Q

NEONATE:
SUPINE

HEAD

LE

UE

ACTIONS

A

head:
slightly ROTATED: not enough muscle control to maintain midline
***low tone babies heads are more turned to the side because have more mobility

UE: arms kept close to the body

shoulder: ADDUCTED, ER
elbow: FLEXED
forearm: PRONATED
- (need supination for a good grasp)
hands: may be FISTED or loosely flexed

LE:
hips FLEXED, ABDUCTED, ER
knee FLEXED
ankle DORSIFLEXED

Actions
RANDOM kicking of both LEs: helps to support pelvis. pelvis frequently moves because of the lack of dissociation.

PT pull to sit by UEs: HEAD LAG

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10
Q

FIRST MONTH

SUPINE

  • -head
  • -neck
  • -arms
  • -LE
A

head: TURNS FURTHER TO SIDE
* Neck Righting Reaction: turn head and neck causes the body to follow in a log roll spontaneously –may not occur with low tone babies
arms: no longer close to body: more ABDUCTED

LE: Random kicking

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11
Q

Neck Righting Reaction:

A

first month supine

turn head and neck causes the body to follow in a log roll spontaneously

–may not occur with low tone babies

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12
Q

FIRST MONTH

PRONE

  • -head
  • -neck
  • -arms
  • -LE
A

UE
more ABducted and ER: moving away from body

LE
hip less flexion, but still flexion: hip flexors elongating enabling pelvis to LOWER

at rest: more LE extended
–hip flexion increases when baby is active such as when lifting and turning head

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13
Q

FIRST MONTH Prone LE review:

what do LE do at rest

what do LE do when active

A

at rest:
more LE extended

active:
hip flexion increases when baby is active such as when lifting and turning head

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14
Q

Summary 1st Month

A

follows with eyes TO MIDLINE (not past midline)

more extension: stretch out more

more head and cervical mobility: allow baby to turn head further

prone: baby lifts head and turns to either side

less proximal tightness in shoulders and hips:

  • -shoulders ABduct and ER
  • hips EXTEND
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15
Q

Infant carrying positions

over shoulder

LE abducted

LE adducted

A

OVER THE SHOULDER
promotes head extension/head lifting and some rotation (antigravity)

LE ABducted
encourages head rotation

LE ADducted:
in low tone baby the hips are always splayed out into abduction so we want to hold them with hips adducted

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16
Q

SECOND MONTH

summary

visual tracking

head lag

head and body

tone

kicking

A

(asymmetrical month)

HEAD
visual tracking PAST MIDLINE from side to side

head lag

POSTURE
posture: asymmetry of head and extremities predominates (note relation of head and shoulder)

TONE
more extended: gravity elongating flexors

LE
bilateral symmetrical kicking

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17
Q

SECOND MONTH

prone

A

HEAD
lift head ASYMMETRICALLY

  • -SCM assist upper traps in lifting head
  • -HEAD NOT IN MIDLINE

(ATNR)

head may bob when it is lifted

UE
elbows behind shoulders
scapula ADDucted and elevated

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18
Q

THREE MONTHS

Prone

Supine

A

SYMMETRY and MIDLINE orientation are more dominant
–asymmetry is not uncommon

PRONE: lifts head 45-90 degrees and maintain midline because of bilateral contraction of paired extensor muscles

SUPINE: can turn head side to side and briefly maintain it in midline

ACCIDENTAL ROLLING: prone: head rotates causing weight shifting and then the shoulder girdle collapses and baby rolls to the side

FROG LEG: UE/LE characterized by bilateral abduction and ER: LEs appear frog leg

**BRING HANDS TO THEIR BODY: important in establishing body awareness

Prop on forearms: elbows in line or in front of shoulders

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19
Q

what important thing happens at three months

A

MIDLINE–can have head in midline

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20
Q

three months: head lifting in prone

  • how high
  • midline?
  • how?
A

PRONE:
lifts head 45-90 degrees
maintain midline
because of bilateral contraction of paired extensor muscles

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21
Q

ACCIDENTAL ROLLING:

age

how

A

3 months

prone: head rotates causing weight shifting and then the shoulder girdle collapses and baby rolls to the side

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22
Q

FROG LEG

appearance

A

3 months old

UE/LE characterized by bilateral abduction and ER: LEs appear frog leg

**BRING HANDS TO THEIR BODY: important in establishing body awareness

Prop on forearms: elbows in line or in front of shoulders

**may persist later in low tone baby

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23
Q

When in prone are elbows in front of or behind shoulders?

A

2 months: elbows behind shoulders
scapula ADDucted and elevated

3 months: prop on forearms: elbows in line or in front of shoulders because UE/LE characterized by bilateral abduction and ER:

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24
Q

THREE MONTHS

sitting

  1. pull to sit
  2. unsupported sitting
A
  1. Pull to sit:
    –head lag
    shoulder elevation and neck hyperextension

[need bilateral symmetrical capital and neck flexors to bring head in midline, antigravity flexors to not have head lag]

  1. Unsupported sitting: falls forward
    head righting noted extends head
    scapula adduction to reinforce extension
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25
Q

what does baby need to not have head lag

A

need bilateral symmetrical capital and neck flexors to bring head in midline, antigravity flexors to not have head lag

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26
Q

Indications for possible disturbances in motor development:

head in midline

WB on forearms

A
  1. inability to assume and maintain head in midline: asymmetrical head position causes the infant to WB more on one side
  2. inability to WB on forearms: baby will not be able to develop ANTIGRAVITY EXTENSION

(if strong ATNR, you cannot break?)

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27
Q

FOUR MONTHS

SUPINE

A
  1. head in midline
  2. tuck chin: chin tuck needed for cervical spine stability –need stability for oral motor control-DROOLING
  3. bring hands together : hand to trunk and mouth occur because of trunk stability
    - -in sitting head goes down to hands because of trunk instability
  4. legs more in line with lower body: increased extension, increased aDduction and less ER. Less frog leg positioning in supine and prone

***low tone babies may maintain frog leg position longer

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28
Q

CHIN TUCK

when develop

why do we need chin tuck?

A

4 months

need neck balanced flexion and extension for a chin tuck

chin tuck needed for cervical spine stability

need stability for oral motor control-DROOLING

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29
Q

what muscle need in prone on elbows

A

serratus anterior for prone on elbows

need elongate scapulohumeral muscles

need neck balanced flexors and extensors for a chin tuck

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30
Q

What is chin tuck a sign of?

A

cervical stability

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31
Q

what does open mouth posture indicate?

A

congestion and mouth breather because cannot breath through nose ie cleft palate

hypotonia in mouth and open mouth posture

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32
Q

FROG LEG

what can happen if baby cannot break out of frog legged position? (6)

what carrying position do we reccomend

A

should see less frog leg at 4 months

  1. interfere with ABDOMINAL CONTROL and UPRIGHT CONTROL: lumbar spine extended, hip flexors tight, pelvis tilted anteriorly
  2. lack of LATERAL weight shifting: blocks transitions
  3. interfere with AMBULATION: bc poor LE dissociation
  4. cannot initiate isolated antigravity knee flexion
  5. prevent POSTERIOR PELVIC TILT: lack of hip flexion with adduction
  6. inefficient pelvis stabilization: bc hip abductors remain shortened

**Carrying position to recommend: ADDUCTION

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33
Q

FROG LEG

A

3 months old

UE/LE characterized by bilateral abduction and ER: LEs appear frog leg

**BRING HANDS TO THEIR BODY: important in establishing body awareness

Prop on forearms: elbows in line or in front of shoulders

**may persist later in low tone baby

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34
Q

Benefit of kicking

who doesnt kick

A

helps mobilize the pelvis for tilting

low tone baby doesnt do it

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35
Q

FOUR MONTHS

summary

  1. EYES
  2. HEAD
  3. neck
  4. HANDS
  5. LE
A
  1. eyes move independent of head, eye tracking
  2. head in midline, tuck chin (cervical stability)
  3. neck: neck muscles developed enough to allow the infant to sit with support and KEEP HEAD UP
  4. hands: bring hands together: hands to midline + hand to hand exploration
    * **grasp: ulnar grasp
    * *bilateral reaching pattern (one arm usually dominant in the reaching)
  5. more anterior and posterior pelvic motions: alternating symmetrical bilateral mass LE flexion and extension kicking affects pelvis.

Extend LE: pelvis anterior tilts

saggital pelvic mobility

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36
Q

FOUR months

hands to trunk and mouth occur because…

A

trunk stability

in sitting head goes down at 4 months because of trunk instability

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37
Q

What age can infant sit and keep head up

A

4 months

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38
Q

Extend LE: what does pelvis do

A

pelvis anterior tilts

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39
Q

What age: eyes move independent of head, eye tracking

A

4 months

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40
Q

FOUR MONTHS

Grasp

A

Ulna side of hand to grasp toy–pick up object by using the palm and outside border of the hand

once grabbed the other hand can hold the object

CANNOT TRANSFER TOY FROM HAND TO HAND

  • thumb NOT involved in grasp—>therefore baby drops object
  • wrist will be flexed: long finger flexors cross the wrist and they are tight
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41
Q

Ulna Grasp

A

4 MONTHS

GRASPS THE OBJECT WITH THE RING FINGER AND THE LITTLE FINGER AGAINST THE PALM

Ulna side of hand to grasp toy–pick up object by using the palm and outside border of the hand

once grabbed the other hand can hold the object

CANNOT TRANSFER TOY FROM HAND TO HAND

  • thumb NOT involved in grasp—>therefore baby drops object
  • wrist will be flexed: long finger flexors cross the wrist and they are tight
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42
Q

FOUR MONTHS

reaching pattern

A

BILATERAL reaching pattern, uses bilateral reaching patterns except one arm usually does the reaching: dominant

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43
Q

FOUR MONTHS

supine

  1. head
  2. tuck chin:
  3. bring hands together
  4. legs more in line with lower body
A

**can roll to side-lying via symmetrical flexion (or the primitive method via extension)

  1. head in midline
  2. tuck chin: chin tuck needed for cervical spine stability –need stability for oral motor control-DROOLING
  3. bring hands together : hand to trunk and mouth occur because of trunk stability
    - -in sitting head goes down to hands because of trunk instability
  4. legs more in line with lower body: increased extension, increased aDduction and less ER. Less frog leg positioning in supine and prone

***low tone babies may maintain frog leg position longer

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44
Q

FOUR MONTHS

sidelying

—–3 benefits

A

encourage parents to place infant to side lie for play!!

  1. New visual and vestibular orientation
  2. contributes to ribcage shaping–rib cage shaping affected by gravity and oblique muscle pull
  3. facilitates antigravity lateral head righting –lateral flexion demands balance flexors and extensors

***TORTICOLLIS: put baby into sidelie to work their lateral head flexion

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45
Q

FOUR MONTHS

prone

Prone on Elbows: 5 things

–benefits (3)

A

Lifts head to 90 degrees in midline

–prone on elbows
1-forearm weightbearing
2-pelvis stabilized
3-UEs out of neonate position -scapulothoracic elongation (elbows under shoulders)
4-chin tuck
5-WS occurs (the direction of the WS supinates the forearm, this lays the foundation for active supination. without supination will not develop grasp. WS is also a prerequisite for reaching)
**no forward reaching–shoulder girdle control will be insufficient to support unilateral WB

  • -prone on extended elbows: prepares child for 1. protective reactions
    2. reaching
    3. quadruped

*have baby reach**no forward reaching–shoulder girdle control will be insufficient to support unilateral WB

MAY SEE ACCIDENTAL ROLLING FROM PRONE TO SIDELYING: weight shift shoulder collapses arm is tucked under, baby rolls

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46
Q

FOUR MONTHS

Rolling: 2 methods

which is preferred?

A

SUPINE–> SIDELIE
1. roll to sidelie via symmetrical flexion: hips and knees flexed and hands on knees, head rotates (neck righting reaction) trunk rotates to side

  1. roll to sidelie vs extension: baby uses marked head and neck extension, more primitive method

FLEXION PREFERRED BECAUSE IT STIMULATES LATERAL FLEXION

PRONE–>SIDELIE
***MAY SEE ACCIDENTAL ROLLING FROM PRONE TO SIDELYING:
weight shift shoulder collapses arm is tucked under, baby rolls

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47
Q

FOUR MONTHS

pivot prone

  • –what is it part of
  • -what muscles used
  • -when is it seen
A

initial phases of Landau (massive extension)

Bilateral Scapular ADuction

seen prior to reaching for a toy

Baby alternates positions: pivot prone and prone on elbows

MAY SEE ACCIDENTAL ROLLING FROM PRONE TO SIDELYING: weight shift shoulder collapses arm is tucked under, baby rolls

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48
Q

FIVE MONTHS

SUPINE

UE (3)

LE (3)

A

UPPER EXTREMITY
1. can hold bottle

  1. UNILATERAL REACHING:
    objects presented at infants side
    unilateral reach across body may cause baby to roll to sidelie
  2. RADIAL PALMAR GRASP: thumb and 2nd and third digits: able to hold object firmly in center of hand
    (not yet able to hold with space between object and palm)

LOWER EXTREMITY
1. HAND TO FOOT: pelvic mobility: A/P tilts
both hands to one foot
foot to open mouth

  1. BRIDGING
  2. BEGIN TO DISSOCIATE LE MOVEMENT: flex one leg while extending the other
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49
Q

FIVE MONTHS

Rolling

A

SUPINE–>PRONE
flexion initiates transitions via LATERAL FLEXION/ and EXTENSION completes the roll

  • **turn head and roll to side via symmetrical flexion
    1. lateral flexion head and trunk (help further into roll)
  1. bottom arm free, it must ABduct to move out from under the body to assume a forearm weight bearing position (need to WS to get arm free)
  2. LE dissociate: extend and IR bottom leg

*** baby may stop in sidelie and play: use LE for positional stability, we encourage sidelie play (isntruct parent in sidelie lift)–rib cage development, use extremities differently

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50
Q

FIVE MONTHS

PRONE

HEAD (2)

UE (2)

LE (1)

significance

A

PRONE ON ELBOWS
HEAD:

  1. lift head to 90 degrees in midline
  2. chin tuck

UE
1. forearm weight bearing

  1. UEs out of neonate position: scapulohumeral
    elongation

LE:
1. pelvis stabilized

significance
**weight shift occurs, the direction of the weight shift: supinate forearm: this lays the foundation for active supination

*need supination for grasp
*WS is a precursor for reaching
no forward reaching, shoulder girdle control insufficient to support unilateral WB

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51
Q

FIVE MONTHS

prone on extended arms

what does it prepare child for? (3)

A

prepares the child for

  1. Protected reactions
  2. Reaching
  3. Quadruped–need extend elbows: if not, do splinting so they can get a feel for what it is like
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52
Q

FIVE MONTHS

activity to do with prone

A

forward overhead reaching with both hands to grasp a toy

benefit:
scapulohumeral elongation

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53
Q

FIVE MONTHS

lateral head flexion

MUSCLES (2)

REACTIONS STIMULATED (3)

A

**torticolis: one side not laterally flex –stuck and stuff will suffer

MUSCLES: must have obliques muscle activity to maintain sidelie without rolling.
Must have balanced flexors and extensors
1. oblique abdominals: must stabilize thorax ti allow the head to flex laterally

  1. quadratus lumborum: laterally flexes the trunk

Reactions stimulated because flex head laterally:

  1. optical head righting reaction: visual feedback is used to orient eyes with the horizon
  2. Labyrinthine Righting Reaction: labyrinthine system causes the head to be placed in the proper position against gravity
  3. Body Righting Reaction on the Head: asymmetrical tactile stimulation to the body causes the head to right itself
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54
Q

FIVE MONTHS

How does optical head righting reaction help with lateral head flexion?

A

optical head righting reaction: visual feedback is used to orient eyes with the horizon

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55
Q

FIVE MONTHS

How does Labyrinthine Righting Reaction help with lateral head flexion?

A

labyrinthine system causes the head to be placed in the proper position against gravity

56
Q

FIVE MONTHS

How does Body Righting Reaction on the Head help with lateral head flexion?

A

asymmetrical tactile stimulation to the body causes the head to right itself

57
Q

FIVE MONTHS

Muscles needed to maintain sidelying without rolling

A

MUSCLES: must have obliques muscle activity to maintain sidelie without rolling.
Must have balanced flexors and extensors

  1. oblique abdominals: must stabilize thorax ti allow the head to flex laterally
  2. quadratus lumborum: laterally flexes the trunk
58
Q

FIVE MONTHS

sidelying

2 benefits

what is needed to achieve it

what muscles needed

A

BENEFITS
1. asymmetrical proprioceptive and tactile input

  1. stimulated head righting

POSSIBILITY
**lateral righting possible if balance between flexor and extensors

MUSCLES: must have obliques muscle activity to maintain sidelie without rolling.
Must have balanced flexors and extensors

  1. oblique abdominals: must stabilize thorax ti allow the head to flex laterally
  2. quadratus lumborum: laterally flexes the trunk
59
Q

FIVE MONTHS

Supine–>Sidelying Rolling

A

roll via extension:

push with LE hyperextends head and trunk
extension reinforced

(slide was missing, something about lacking lateral flexion and LE…)

60
Q

TYPES OF SITTING

A
  1. Propped Sitting
  2. Ring Sitting
  3. Half Ring Sitting –begin to dissociate LE (one leg in one posture and the other in another posture-ie one leg in neutral and other in ER and abbduct)
  4. long sit
  5. side sit
61
Q

FIVE MONTHS

Propped Sitting

-how does baby use distal fixing here?

  • head
  • UE
  • LE
A

when leaning forward baby returns to sitting erect: initially baby will use scapular adduction and thoracic extensions
(distal fixing: using distal shoulder to control proximal extensors)

  1. Head control: can move head without losing balance
  2. UE:
    bilateral UE support: cannot use UE for play
  3. Trunk/LE:
    provides positional stability [hip ABduct, ER] = frog leg in sitting
    —–EXTENSORS: inactive trunk and hip extensors, rounded trunk
    —–FLEXORS: trunk flexed because of hip flexors

(still need coactivation around the hips, with increasing hip strength and spinal extension baby will sit erect using these muscles for indp sitting)

62
Q

FIVE MONTHS

Hallmarks @ 5 months

A

1: hands to knees, hands to feet

63
Q

What does a baby need in order to sit independently? (that not have at 5 months)

A

coactivation around the hips

with increasing hip strength and spinal extension baby will sit erect using these muscles

64
Q

FIVE MONTHS

–what does it mean if forward trunk flexion after 7 months

A

red flag for poor control of these muscles:
1-abdominal
2-erector spinae
3-hip

abdominal hip extensor tone displace weight posteriorly and the lack of abdominal strength to counteract the pull

need hands free to explore the world

65
Q

FIVE MONTHS

Rolling

accidental vs volitional

A

accidental before volitional rolling:
—accidental because have asymmetrical WB head tilted to one side, weak shoulder, not get scapulohumeral elongation

ACCIDENTAL ROLLING:
0-3 months: LOG ROLLING to side
—three months: prone: head rotates causing weight shifting and then the shoulder girdle collapses and baby rolls to the side

VOLITIONAL ROLLING BEGINS 5-6 MONTHS

1. ROLL TO SIDELYING
four months: roll to side
-roll to sidelie via symmetrical flexion:
- roll to sidelie vs extension: 
- prone-->sidelying
  1. first: PRONE–>SUPINE
  2. second: SUPINE–>PRONE
    Supine–>prone: flexion initiates transitions via lateral flexion and then extension completes the roll
    Supine –> sidelie vis extension

**MUST ROLL BOTH SIDES, IF INFANT DOESNT IT IS A RED FLAG
spasticity can cause stiffness through the trunk, interfering with coordinated rolling movement

66
Q

Red Flag: infant does not roll over (prone-supine or supine-prone) both to the left and to the right

A

*MUST ROLL BOTH SIDES, IF INFANT DOESNT IT IS A RED FLAG

spasticity can cause stiffness through the trunk, interfering with coordinated rolling movement

67
Q

When?

ACCIDENTAL ROLLING:

A

ACCIDENTAL ROLLING:
0-3 months: LOG ROLLING to side
—three months: prone: head rotates causing weight shifting and then the shoulder girdle collapses and baby rolls to the side

68
Q

When?

VOLITIONAL ROLLING:

A

VOLITIONAL ROLLING BEGINS 5-6 MONTHS

1. ROLL TO SIDELYING
four months: roll to side
-roll to sidelie via symmetrical flexion:
- roll to sidelie vs extension: 
- prone-->sidelying
  1. first: PRONE–>SUPINE
  2. second: SUPINE–>PRONE
    Supine–>prone: flexion initiates transitions via lateral flexion and then extension completes the roll
    Supine –> sidelie vis extension
69
Q

Order to develop volitional rolling

A
  1. roll to sideliying
  2. prone to supine
  3. supine to prone
  • issue today of less tummy time in prone to develop this
  • if they only roll to one direction note it
70
Q

SIX MONTHS

sitting

A

UNSUPPORTED RING SITTING
—head rotates: infant falls

  1. props arms forwards but not sideways
    reach in front to play with toy but not to side
  2. LE used for positional stability to prevent lateral weight shift
    * **Bilateral ABduct and ER block weight shifting
71
Q

RING SITTING

when

position

pros (1)

cons (3)

A

when: SIX MONTHS: unsupported ring sitting

position:
1. LE used for positional stability to prevent lateral weight shift
* **Bilateral ABduct and ER block weight shifting

  1. high guard arm positioning: scapula ADduction

PROS:
1. stable:
— cannot laterally weight shift
free arms for play!

CONS:
1. props arms forwards but not sideways
reach in front to play with toy but not to side

  1. If used exclusively: contributes to tightness in hip flexors, ABductors, ERs, and Hamstrings
  2. difficult to transition out of ring sitting

***older infants revert to ring sitting when engaging in a fine motor task

72
Q

When do older infants revert to ring sitting ?

A

older infants revert to ring sitting when engaging in a fine motor task

73
Q

SIX MONTHS

pivot prone

  • –what is it in development
  • –what is a pro
  • –what is it alternated with
A

4-6 months

mature Landau

prone is a functional position

alternate this with prone on extended arms

74
Q

SIX MONTHS

how does baby move around in pivot prone

A

uses this to get toys

TURNING: pivoting in prone–pivots in a circle: head and trunk in lateral flexion:

  1. skull side arm pushes
  2. face side arm to reach

FORWARD AND BACK: bilateral symmetrical pushing causes the baby to slide forward and back

*weight shift for reaching

(difficulty may be due to: weakness, inability to weight shift, tonal disturbances)

75
Q

Atypical Pivoting in Prone

A
  1. asymmetrical: infant rotates to only one side
  2. fails to use other forms of locomotion by 9 MONTHS—should be doing quadruped
  3. difficulty may be due to:
    - – weakness
    - – inability to weight shift
    - – tonal disturbances (incr/decr)

Need WS, Elongate and Shorten sides
need lateral flex one side and elongate the other sides
**torticolis:
**brachial plexus injury

76
Q

Difficulty moving in pivot prone may be due to (3)

A

difficulty may be due to:

  • – weakness
  • – inability to weight shift
  • – tonal disturbances (incr/decr)
77
Q

SIX MONTHS

Standing

A
  1. FULL WEIGHT BEAR at 6 months (bear partial weight at 5 months) –wont drop to the floor
  2. Hips and knees FLEXED
  3. feet PRONATED–fat pad at longitudinal arch and not develop ankle yet
  4. may bounce
78
Q

SIX MONTHS

Fine Motor (4)

A
  1. finger feeds
  2. palmar grasp
  3. transfer toys hand to hand
  4. shakes and bangs toys
79
Q

What may be problem that child cannot sit independently (5)

A

7-9 months!!!

  1. low tone
  2. poor trunk extension
  3. tight hip extensors causes child to fall backwards
  4. instability of pelvic/femoral:
    weak hip extensors: baby must lean forward and prop
80
Q

SEVEN MONTHS

Supine

A
  1. Roll: supine –> prone
  2. lifts head more :
    antigravity flexor control: must have obliques muscle activity to lower and stabilize rib so that the head can move
  3. strong lateral flexion

will prefer PRONE because it is more functional
if prefers supine then further observation is needed

81
Q

SEVEN MONTHS

does baby prefer prone or supine

red flags

A

will prefer prone because it is more functional

if prefers supine then further observation is needed

82
Q

SEVEN MONTHS

PRONE

A

prone is functional and allows mobility

transitions prone –> quadruped

heavy babies stay on their bellies longer and do not assume quadruped as soon (not enough strength to push up)

low tone babies frequently have difficulty assuming quadruped (lack stability)

83
Q

SEVEN MONTHS

What babies have difficulty assuming quadruped ?

A

heavy babies stay on their bellies longer and do not assume quadruped as soon (not enough strength to push up)

low tone babies frequently have difficulty assuming quadruped (lack stability)

84
Q

SEVEN MONTHS

Quadruped

7-9 months

A
  1. co-contraction of hip musculature for stability around hip joints
  2. LE positioning to accept weight: KNEES ARE UNDER HIP.
    [low tone child knees are not under hip. discourage carrying over mothers hip, consider hip helpers to avoid abduction]
  3. Flat back because lumbar spine is stabilized: balanced musculature
85
Q

SEVEN MONTHS

Quadruped: KNEES UNDER HIP

  • -what child won do this
  • how should mothers not carry child
  • what should be used for position to avoid a position to prevent issue here

7-9 months

A

LE positioning to accept weight: KNEES ARE UNDER HIP.

*work to extend hip to get the knees behind the hip, need stable core to do that, if they do not do it is a compensation for a weak core

low tone child knees are not under hip

—discourage carrying over mothers hip

—consider hip helpers to avoid abduction

86
Q

SEVEN MONTHS

Babies that have problems with Quadruped

7-9 months

A
  1. baby’s size
  2. Poor UE weight bearing
  3. Poor UE weight shifting
  4. poor LE dissociation
  5. excessive hip mobility, poor pelvic control
  6. poor trunk control

first assume quadruped anterior pelvic tilt: DF ankles

as abdominals and hip extensors increase control they modify the pelvic position

87
Q

SEVEN MONTHS

how is quadruped different when increase abdominal and hip extensor control?

7-9 months

A

first assume quadruped anterior pelvic tilt: DF ankles

as abdominals and hip extensors increase control they modify the pelvic position

88
Q

SEVEN MONTHS

Immature Quadruped Position

  • -how may the muscles be affecting an incorrect quadruped position?
  • -knee not under hip (2)
  • -lumbar lordosis (2)

7-9 months

A

Knee not under hip
hip ABduct and ER: LE in poor WB position: knee not under the hip
overactive hip flexion

lumbar lordosis:

  • –indicates weak abdominal, or inactive abdominal
  • –overactive hip flexors: to stabilize the hip anteriorly tilting the pelvis causing a lordosis
89
Q

SEVEN MONTHS

What are “hip helpers”?

A

prevent hip abduction, splaying of the hips

support shorts to limit excess hip abduction in babies and toddlers with low muscle tone to improve rotational movements
—low tone seen in Downs syndrome, hypotonia

[excess mobility will interfere with assuming quadruped position]

LIMITS “W” SIT

90
Q

SEVEN MONTHS

Quadruped
7-9 months

rocking

A

rocking forwards and backwards helps develop hip joint stability

rock forwards and backwards: must be stable to rock

as control increases lateral (Z) and diagonal (Y): weight shifting occurs

encourage
assume–> maintain –> rock–>reach

91
Q

SEVEN MONTHS

order of movement developing axes

A

sagital –> frontal –> transverse rotation

need x and z to get rotation

92
Q

SEVEN MONTHS

Quadruped progression to encourage

7-9 months

A

assume position –> maintain position –> rock–>reaching

93
Q

SEVEN MONTHS

crawling (not complete) = bunny hopping

A

bunny hopping [uses extended arms and pulls with flexed hips and knees]

uses bilateral symmetrical LE and UE movements

used because:
1. cannot lateral WS

  1. no LE dissociation
  2. no diagonal trunk control (need to reach forward with arm and contralateral leg to crawl normally)

SPASTIC DIPLEGIA

94
Q

pediatric immobilizers–why we would use them

A

to encourage weight bearing on the involved UE during play in quadruped

then moving on to creeping

95
Q

EIGHT MONTHS

!!!!!!INDEPENDENT SITTING!!!!!!!!!

A

7-9 months

sit functional: independent sitting

  • -may use positional stability (frog leg, ring sit)
  • -beginning to use a variety of sitting positions

RED flag: IF NOT SITTING INDEPENDENTLY

96
Q

EIGHT MONTHS

RED FLAG

A

RED FLAG:

NOT SITTING INDEPENDENTLY

97
Q

EIGHT MONTHS

Pull to stand: early attempts (4 motions to do it)

Sitting Down

A

pull to stand (may see at 7 months)

early attempts (may first begin in the crib):

  1. fix pelvis into anterior pelvic tilt
  2. primarily uses UEs: places arms on surface and pushes down or pulls with the arms to rise to stand
  3. then forward weight shift
  4. uses symmetrical LE extension to assist

***DOES NOT KNOW HOW TO SIT: FALLS TO SIT DOWN

98
Q

10-12 MONTHS

PULL TO STAND (2)

–what indicates more stability

A
  1. uses LE more actively than he did at 8 months!!
    lateral WS: flexes non weight-bearing hip and places foot on the floor (1/2 kneeling, proposal)
  2. uses UE for balance (not for the motion to happen)
    - as stability improves using one hand and pulls up on less stable objects
    - Improved stability: go from gripping to palming the surface with an open palm
99
Q

10-12 MONTHS

Stand–>Sit

–what it requires

A

Squats: quadriceps eccentrically contracting

—-without eccentric quad control will fall: work on graded knee control: picking up toys from different surfaces
(without this control on stairs they do step to pattern and when running they do a gallop run if lack midrange control and keep knees stiff)

May drop Toys down to practice lowering self

100
Q

10-12 MONTHS

Bear Walking

–what it requires (5)

A
  1. stable shoulder girdle
  2. activate abdominals (look for ripples to see contractions)
  3. LE mobility
  4. feet must PUSH against the floor (not pull)
  5. elongates hamstrings and gastroc (need
    extension)

good position to work towards and in for infants with movement difficulties especially high tone and low tone

101
Q

NINE MONTHS

side-sit

A

side sit at 9 months (sitting with one leg like a w sit and the other leg like a half ring sit)

  1. axial rotation
  2. elongation of the trunk on the WB side
  3. lumbar extension
  4. LE dissociation:
    one hip ER and ABduct
    other hip IR and ADduct

A COMBINATION OF RING SITTING AND “W” SITTING

102
Q

“W” Sitting

-what is it associated with

A

W sitting is a normal sitting position, typical if it is part of a variety of sitting postures
***IF USED EXCLUSIVELY: leads to decreased control of trunk and hips

  1. associated with low tone (posterior pelvic tilt)
    - -no pelvic rotation and no lateral weight shifting: trunk muscles are not challenged,
    - - W sitters lack trunk and pelvic stability
    - -using LE posturing for stability rather than muscle activity to stabilize the pelvis
    - -if used exclusively leads to decreased control of trunk and hips
  2. reinforces femoral anteversion: femoral anteversion associated with toe-in gait

**if a child has hip dysplasia the extremes of internal rotation could put the child at risk for dislocation

  1. stretches the MCL of the knee: later may contribute to genu valgum: knock knee position in standing
  2. associated later in life with developing a SWAY BACK POSTURE
103
Q

W sit: low tone

A

W sit associated with low tone (posterior pelvic tilt)

  1. no pelvic rotation and no lateral weight shifting: trunk muscles are not challenged,
  2. children who use W sit all the time lack trunk and pelvic stability
  3. using LE posturing for stability rather than muscle activity to stabilize the pelvis

–if used exclusively leads to decreased control of trunk and hips

104
Q

Effect of W Sit on the Femur

A

reinforces femoral anteversion: femoral anteversion associated with toe-in gait

**if a child has hip dysplasia the extremes of internal rotation could put the child at risk for dislocation

105
Q

Effect of W sit on the knee

A

stretch MCL

later may contribute to genu valgum: knock knee position in standing

106
Q

Effect of W sit on trunk and hips

A

***IF USED EXCLUSIVELY: leads to decreased control of trunk and hips

107
Q

TALL KNEELING

10-12 Months

–which muscles

A

without UE support:

  • quadriceps contract to elevate the body
  • hip extensors stabilize trunk
  • **if hip flexors are used to stabilize–slight anterior pelvic tilt and DF

maintain hip flexion, ABduction and ER
–if strong hip flexor contraction: anterior pelvic tilt and DF

difficult for baby to extend hips in kneeling: rectus femoris is tight, gluteus maximus is weak

108
Q

Cruising

what it requires (3)

what we may see and why (2)

what strength it builds up

A

SIDESTEPPING: so that pelvis does not have to rotate

REQUIRES
1. Hip ABduction and hip ADduction control

  1. UE stability
  2. LE weight shift

WHAT WE MAY SEE
1. toe curling to increase stability (distal fixing for proximal stability)

  1. shoulder elevation to increase postural stability

***BUILDS UP HIP ABDUCTOR STRENGTH

109
Q

STANDING

11-14 months

A

arms used for stability

  1. Bilateral–if not then places trunk on the surface
  2. As stability increases diagonally turns away and supports self with one UE
  3. may take first step without UE support when reaching to another surface

less hip and knee flexion

raise up on toes in picture

110
Q

Supported Walking

10-12 Months

shoulder

pelvis

hips

ankle

foot

A

two hands held–>one hand held

SHOULDER
fixing: scapula adduction: facilitates spinal extension

PELVIC
Anterior pelvic tilt

HIPS
hip ABduction and ER: wide BOS: in stance and in swing phase of gait

ANKLE:
everted heels

FOOT:
***NO HEEL STRIKE

111
Q

Early Gait Characteristics

STABILITY (4)

indp gait at 10-15 months

A
  1. wide BOS: hips ABducted and ER (toe out)
  2. Thoracolumbar extension to control the forward displacement of the body (need to align ribs over pelvis to facilitate abdominals)
  3. Oral mechanism contributes to head, neck and shoulder stability
  4. UE fixing: to stabilize shoulder girdle and upper trunk

mature gait: age 3

112
Q

When see mature gait characteristic

A

age 3 years

113
Q

Early Gait Characteristics

WS

UE

HIP

KNEE

ANKLE

A

Lateral Weight Shift through displacement of the head and shoulders and upper body

UE:

  1. if walking to parent: shoulders flexed and outstretched
  2. stabilizing fixing: HIGH GUARD positioning arms move in and out of fixing pattern –one arm may be at side then with the next step in stabilizing position
  3. NO RECIPROCAL ARMSWING

HIP
1.excessive hip flexion throughout the entire gait cycle

  1. hip extension varies to absent at terminal stance to a few degrees prior to toe off
  2. hip ER throughout entire gait cycle: toe out

KNEE
1. knee flexed through midstance with very early walkers gradually it is reduced and knee extension increases

ANKLE
1. new walkers have absent heelstrike: go straight into footflat contact: or PF contact

  1. relative footdrop in swing phase
  2. PLANTAR FAT PAD: pronation
    (disappear at age 2 years and longitudinal arch becomes visible)
114
Q

81 minutes in prone

A

infants spending 81 minutes in prone achieve greater success in acquiring:

prone, supine and sitting milestones comparing to those infants that spend less time

(infants tend to spend most time in supine)

115
Q

FIXING

why is it used

A

it is used to decrease the degrees of freedom at a joint

can occur when a child is learning a new skill

can be used for stability and to control movement.

*lack of head control: neck hyperextension and shoulder girdle elevation in sitting is compensated for poor postural stability

116
Q

ATYPICAL (6)

0-2 Months

A 
1-strong extension
2-unable to lift head in prone
3-no WB in supported standing
4-no kicking
5-strong asymmetrical postures
6-hypotonia
117
Q

ATYPICAL (4)

3 months

A

1) SUPINE: minimal kicking
2) no hands on body exploration
3) unable to lift head
4) no attempt to lift head when pull to sit

118
Q

Atypical (6)

4 months

A

1) poor MIDLINE orientation of head and hands
2) unilateral UE use
3) prone unable to LIFT HEAD
4) pull to sit, no assist with HEAD LIFT
5) unable to RING SIT
6) no WB in supported standing

119
Q

Atypical (5)

5 months

A

1) supine: no hands to feet or foot to mouth, poor midline orientation
2) rolls to side via extension
3) sidelie: no lateral flexion, no LE dissociation

4 )cannot ring sit

5) no WB or extension in standing

120
Q

Atypical (3)

6 months

A

1) prone: maintains frog leg position, no UE WB
2) pull to sit: head lag, shoulder elevation (traps instead), no initiation
3) standing: WB on toes, LE extended

121
Q

Atypical (5)

7 months

A

1) supine: prefers supine
2) prone: not reaching in all directions for toys
3) sitting: independent ring sit only, cannot transition in/out of sitting
4) quadruped: bunny hop
5) standing: no WB or weightshifting, heels not on floor

122
Q

Atypical (3)

8-10 Months

A

1) sitting: “w” or ring only, no transitions in or out, cannot sit independently
2) crawl: bunny hop or no crawling, cannot climb on furniture, scooting on butt
3) standing: weight on toes, unable to weight-shift, unable to reach for or play with toy

123
Q

Atypical (3)

11 Months

A
  • in addition to what was mentioned
    1) no cruising
    2) no forward walking with hands held
    3) commando crawling
124
Q

4 observable stages of postural control

A
  1. LOWEST LEVEL OF POSTURAL CONTROL: infant falls to stop a movement
  2. infant will extend and abduct arms or legs to stop a fall (increase BOS)
  3. lateral righting reaction of the trunk to stop a movement or prevent a fall
  4. MATURE LEVEL OF POSTURAL CONTROL:: equilibrium reactions to stop a movement or a fall–balance of extensors and flexors: lateral and diagonal movements
125
Q

protective response

  • purpose
  • what movements of limbs
  • in standing
  • in sitting
  • when impaired?
A

PURPOSE: regain balance when center of mass has been pushed beyond base of support

movements are in FRONTAL and SAGITTAL planes: aBduction and extension of arms or legs to stop the fall

in standing: stepping strategy

in sitting: forward/ lateral/ posterior protective are used

***IMPAIRED WITH hemiparesis, CMT (torticollis), brachial plexus injury

126
Q

equilibrium reactions

A

infant is tilted slowly off balance, he automatically moves his head, trunk, and limbs in the opposite direction of the tilt to maintain balance

developmental sequence

6 months: prone

8 months: supine, sitting

10-12 months: quadruped

12-21 months: standing

127
Q

equilibrium reactions

–positive if

A

positive if head and trunk righting occurs away from the weight shift

am and leg opposite the weight shift abduct

trunk rotates: curves their trunk in the opposite direction of the tilt to maintain balance

128
Q

Speech and Language (3)

0-3 months

Hearing and understanding

A

1) Startles to loud sounds
2) quiets or smiles when spoken to
3) in response to sound: increase or decrease in sucking

129
Q

Speech and Language (3)

0-3 months

Talking

A

1) cooing and gooing sounds
2) cries differently for different needs
3) smiles when sees you

  • concerning if not making sounds
  • should smile back
130
Q

Speech and Language (3)

4-6 months

Hearing and Understanding

A

1) eyes move in direction of sound (tracks sound)
2) notice toys that make sounds
3) pays attention to music

131
Q

Speech and Language (4)

4-6 months

Talking

A

1) babbling
2) laughs
3) vocalizes excitement and displeasure
4) makes gurgling sounds

132
Q

Speech and Language (3)

7 months-1 year

Hearing and Understanding

A

1) likes peek-a-boo
2) turns and looks in direction of sound
3) understands simple instructions; begins to respond to requests (ie come here or want more)
* social interactions

133
Q

Speech and Language

7 months-1 year

Talking

A

1) uses gestures to communicate

2) 1-2 words (hi, dog, dada, mama)
may not be clear

3) uses speech or non crying sounds to get attention
* concern frustrated if always cries to get attention because cannot communicate

134
Q

RED FLAG/Clinical Signs exist to help identify children at risk for language delay and/or ASD

language delay

autism (ASD = autistic section disorder)

A

1) ANY LOSS OF SPEECH, BABBLING, OR SOCIAL SKILLS AT ANY AGE

BY 12 MONTHS
2) no babbling by 12 months old

3) no back and forth gestures as pointing, showing, reaching, waving by 12 months

BY 16 MONTHS
4) no words by 16 months

BY 24 MONTHS
5) no 2 word meaningful phrases (does not include imitation or repetition) by 24 months

135
Q

Baby Sign Language

A

pre-verbal

teaches:
1. joint attention
2. sign and use the word for the action
3. hand over hand to create the sign
4. imitates the sign look for approximation

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