Atypical Development Flashcards
0-2 months
- Track rattle to midline on both sides
- Grasps rattle and holds for 30 seconds
- On stomach- Lifts and turns head so opposite cheek touches surface
- Elevates head and upper trunk 45 degrees bearing weight on forearms or hands
- Holds back in rounded position when sitting
- Grasp Reflex is present
- ATNR is present
- In supine, the infant has increased variability of movements in their lower extremities.
- In prone, the infant can lift head in 45 degrees of extension for a brief period of time.
- Elbows are behind the shoulder girdle.
3-5 months
- Grasps and holds cube
- Maintaining head in midline, brings both hands to midline while lying on back
- Brings both feet to mouth for play on back
- Maintains short balance while sitting
- Lying on back engages fingers in mutual touching
- During play and exploration the infant uses mouth to explore the hands and toys, hand-to-hand, and hand-to-body contact.
- In prone, the infant can hold head in 90 degrees of extension in midline.
- Forearm weight bearing is present with the occasional extended arms.
- Supine, hands to knees
- Rolling to side
when are the first signs of locomotion?
3-5months
6-8 months
- Picks up two cubes and retains them
- Rolls from back to stomach
- From stomach, raises upper trunk, shifts weight side to side, lifts free arm towards toy
- Grasps both feet on back and holds them
- Maintains balance in sitting while moving hands and arms to grasp toy
- Grasps cube with thumb and first finger and 2nd fingers with space visible between cube and palm
- Sits independently
- Palmar or radial palmar grasp is present
- Rolling from supine-prone; Initiated by flexion, rotation, and lateral weight shift.
- Play, Play, Play!!
Why at 6 months is it that a kid can pick up two cubes
because radial grasp is coming into play.
In regards to development time lines:
* When should we be concerned?
* When should we offer services?
* What should we DO?
physical observations begin when?
3-8 months
what are we assessing at 3-8 months
anti gravity movement, midline, sitting up independently, shifting weight. all that transitional stage. when those things aren’t going on that’s a red flag
What are the main things we are assessing?
- Variability of movement
- movement against gravity
- muscle tone
What is muscle tone
the readiness of the muscle to do it’s job
what would a low tone/ hypotonicity kid have trouble with
balance, strength, postural support, moving against gravity, difficulty with reaching
Common childhood diagnosis that cause low tone
down syndrome, cerebal palsy, prematurity, autism (sometimes) and many other syndromes. brain injuries
common childhood dx that cause high tone
CP, prematurity, brain injury, spinal cord injury and other medical conditions.
Typical supine observation
- Head in midline
- Pelvic lifting (feet off floor)
- Hand movement- against gravity, grasping object
- Eyes- track object 180° side to side
Supine - atypical
- Head asymmetrically to side, does not hold in midline
- Decreased antigravity movement
- Poor to no grasping (any grasping reflexes?)
- Poor or decreased tracking; difficulty at/past midline
- Poor abdominal action
PUll to sit - typical
- Infant leads movement with head
- Chin tuck and abdominal flexion; LEs working, too
- Head is maintained upright in good alignment
Sit
* In supported sitting- can lean forward
* Hold and play with toy
* Good upright posture, supported by trunk/back extension
* Head at midline
PUll to sit - atypical
- Head does not lead PTS
- No chin tuck, has a head lag
- Decreased abdominal and LE activation
- Once upright, still has poor head control and neck hyperextension
Sitting- Excessive extension
* Arm retraction
* With the extensor tone, it is difficult to hold the position and re-right
* Poor trunk control
Prone typical
- Strong extension and adduction in hips and lower extremities for wt bearing
- Good base of support for head and trunk lifting
- Lateral weight shift due to weight bearing on hips and LEs- free arms for reach
- Think about vision, interaction with the environment…PLAY!
prone atypical
- Flexion and abd in hips (decreased WB)
- Shifts weight forward to shoulders
- decreasing ability to lift
- weight bear and weight shift?
- Base of support is decreased
- Can lift head, but uses extensors
- Think about the impact on vision, interaction with the environment, other…PLAY!
rolling typical
- To prone from supine
- Uses antigravity movement
- Lateral head and trunk righting (keeps eye parallel to horizontal surface)
- Side lying rotation noted- demonstrating balanced flexor and extensor muscle activation in trunk
- What does this support in function?
rolling atyical
- Asymmetrical posture
- Decreased lateral head and trunk flexion
- Increased extensor tone
- Shoulder retraction
- How might this impact segmentation?
- Rotation?
- Engagement with environment?
- Keep side lying as a part of rolling in mind… we will see it again.
side lying typical
- Good antigravity alignment
- Head, trunk, hips extended- but still allows for movement
Side lying atypical
- Decreased head trunk and hip extension
- Decreased arm and leg movement
- ATNR observed, impacting head in midline
protective extension - typical
- Both arms spring forward
- Antigravity movement in midline
Protective extension - atypical
- Poor antigravity movement
- Limited/no extension of arms
- Influence of ATNR prevents UEs from both going forward
Standing typical
- Good postural alignment
- Head over trunk over hips and Les
- Bearing weight on flat feet
- Demonstrates movement in legs
- Arms are free in space and have good movement
standing atypical
- Poor alignment
- Head forward, in extension, hips flexed, trunk leaning forward.
- Unable to maintain head in midline- ATNR
- Decreased weight bearing on flat feet
interventions
- Therapists need to increase movement opportunities
- Support children through ranges
- Support through new movement experiences
- Help increase strength- trunk, neck, shoulders, hips
- Increase the feeling of “ease of movement”
- Increase the ranges of movement
- Help create better alignment for sitting, standing, movement in general
- Promotes better function through reach, feeding, self care, etc.
