BIOMED 10/21b Motor Dev 1 Flashcards
development themes
- variability
- expected in young children, but not expected to be the exact same way - range of typical development
- range of when it is typical to develop skills
- interplay o how the child is developing and their environment - Multiple factors impact motor skill acquisition
milestone acquisition
- enviroment and exposure
- musculoskeletal
- predisposition
developmental domains
- sensory
- cognitive
- motor
- communication
how should children respond to sensory stimuli in developmental domains?
- Taste, touch, sound, feel, see
2. Able to respond in the same way as other children their age
what are some issues children may have with cognitive developmental domains
Difficulties reading and writing
what are gross motor patterns
larger motor patterns (PT)
what are fine motor patterns
handwriting and drip (OT)
rate of development
children from different areas, looked at skills via assessment
-all bands overlap and progress with similar
gestational age
time from first date of last menstrual period of mother to the time of birth
- Use in neonatal setting (NICU)
- Need to look at gross motor as if the patient was still in the womb
promenstrual age
period of time from last day of menstrual period to the date of assessment
chronogical age
age on calendar at term and full term
adjusted age
depends on when the child was born in relation to the date of assessment
when is a preterm delivery?
<37 weeks
when is a late preterm delivery
34-36 weeks
what are interventions with late preterm delivered patients?
keep them warm
encourage parents and caregivers for touch and care of the child
ventilatory support
what does it mean to have a very preterm delivery
<32 weeks
how long is a normal full term pregnancy?
37-42 weeks
neonate
1. Gross Motor ◊ Limited ◊ Physiological flexion ◊ Reflexive movements (expect palmar flexion, volitional control is limited) 2. Fine Motor ◊ Not purposeful ◊ Limited ability to self-soothe ◊ Dependent for feeding 3. Communication ◊ Cries to communicate needs
first 3 months
- Gross Motor
◊ Consistently turn head to clear airway (safety)
◊ Increased head control when held
◊ Increased ability to lift the head (extension and rotation)
◊ Range of motion is increasing, but flexion remains (hip and knee) - Fine Motor
◊ Emerging ability to bring head to mouth
◊ Visual regard develops (tracking)
◊ Decreasing arm flexion position
◊ Involuntary release
3. Communication
◊ Cries to communicate needs
◊ Bonding with caregivers
3-6 months
- Gross Motor
◊ Rolling emerges (prone to supine, then supine to prone)
◊ Good head control in supported sit, independent sitting around 5 months
◊ + traction with pull to sit
} Tuck chin and pull up to sit
◊ Props onto forearms
◊ Antigravity kicking
2. Fine Motor
◊ Hands to midline - purposeful reaching
◊ Can grasp a toy
◊ May bring hands to feet
} Improved abdominal abilities
◊ Improving ability to self-soothe
◊ Weightbearing through the hands by end of this period
3. Communication
◊ Cries to communicate needs, but increase in vocalizations
◊ Smiles
◊ Laughs
7-9 months
1. Gross motor ◊ Belly crawling > creeping on hands and knees ◊ Improved sitting balance reactions ◊ Sit with trunk rotation 2. Fine motor ◊ Consistent self-feeding ◊ Bimanual play in sitting ◊ Improved grasp patterns and dexterity 3. Communication ◊ Increasing repertoire of sounds ◊ responds to name ◊ Responds to no
10-12 months
- Gross Motor
◊ Pulling to stand and cruising on furniture
◊ Emerging independent standing
◊ Some children are walking
2. Fine Motor
◊ Improving release and in-hand manipulation
◊ Can use a cup
◊ Practices with a spoon
◊ Pokes a toy to manipulate cause-effect
3. Communication
◊ Vocalizations are consistent for certain items/needs
◊ Repetitive consonant combinations, emerging words
◊ Can provide an object when asked (Give me the cup)
12-18 months
- Gross Motor
◊ Walking
◊ Transitioning floor to stand
◊ Altering speed without loss of balance
◊ Time since ambulation more indicative of function and quality of movement than age
2. Fine Motor
◊ Controlled release of an object
◊ Trap a ball and roll a ball back (sit)
◊ Self-feeding and use of utensils
◊ Holds a crayon in a fist (thumb up) and scribble
3. Communication
◊ Understands simple requests
◊ Identifies 3+ body parts
◊ Separation distress
◊ About 10-15 words
◊ Receptive language > Expressive language
18-24 months
- Gross Motor
◊ - Increased development of gait pattern
◊ - Emerging run
◊ - Stair mobility: creep à standing with railing/ hand held
2. Fine Motor
◊ Improving grip with drawing tools
3. Communication
◊ - Two-part commands
◊ - Understands multiword combination (Daddy running)
◊ - 50-200 words
◊ - Says “NO” more often
2 year olds
- Gross Motor
◊ Negotiates stairs with marking time pattern (foot over foot) à ascending with alternating feet
2. Fine Motor
◊ - Holds a crayon in fingers
◊ - Vertical and horizontal stroke are imitated
3. Communication
◊ - Two-part phrases
◊ - 250+words
◊ - Responds to another child who is upset
◊ - Pretend play
3 year olds
1. Gross motor ◊ - Descends stairs with alternating pattern ◊ - Consistent jumping 2. Fine Motor ◊ - Assisted tooth brushing ◊ - Donning and doffing clothes ◊ - Can draw a circle 3. Communication ◊ - Complete sentences emerge ◊ - Improving grammar and syntax ◊ - May use physical aggression > verbal if upset or frustrated
4 year olds
- Gross Motor
◊ - Hops
◊ - Gallops consistently
◊ - Emerging skip
◊ - Overhand throw with rotation
2. Fine Motor
◊ - Cuts with scissors
◊ - Copies a square and crossed line
◊ - Emerging use of buttons
◊ - Copies letters and may reverse some
3. Communication
◊ - Poses questions
◊ - Recognizes written name and letters
◊ - Correct word arrangement to negate a term
5 year olds
1. Gross Motor ◊ Inconsistent jumping jacks ◊ Emerging forward roll ◊ Can complete an obstacle course with fair accuracy ◊ May still need help on swings ◊ Rides a bike 2. Fine motor ◊ Dynamic tripod grasp ◊ Improving writing endurance ◊ Transition from structured line cues to free writing in class 3. Communication ◊ May understand some words spelled aloud
6 year olds
1. Gross motor ◊ Skips ◊ Rides a bike without training wheels ◊ Can rollerskate 2. Fine motor ◊ Can don a coat and zip it without assistance to start the zipper 3. Communication ◊ Understands humor ◊ Understands homonyms
Milestones
- Prone Tolerance
- Supine Skills
- sitting/supported sitting skills
- standing skills
- transition from floor to stand skills
Prone Positioning tolerance
- ability to turn head and clear airway
- cervical extension (45 degrees by 2 months, 90 degrees by 4 months)
- rolling prone to supine
- swimming
- prone on extended forearms
- belly crawling
- creeping on hands and knees
supine skills
Physiological flexion Maintains head in midline Hands to midline (3-4 months) Hands to knees then feet Feet to mouth Pull to sit without head lag, volitional control Rolling supine to prone
sitting skills
Dependent for head and trunk control
Supported with rounded spine (2-3 months), (+) head control
Prop sitting (4-5 months)
Sitting with hands free (5-6 months)
- initially with wide BOS, then decreases
Sitting and reaching unilaterally
Sitting with bimanual play
Sitting with trunk rotation
Independently transitions into and out of sitting
standing skills
Reflexive standing and stepping
Positive weight acceptance (4 months +)
Pull to stand, but can’t eccentrically control descent
Stands at external support surface
Cruising
Standing with 1, then 2 hands free in high guard
Static standing and assisted walking
Independent walking
Independently transitions floor to stand without external support surface
floor to stand transitions
Pull to stand
Floor to stand through 3-point or bear stance
Floor to stand through ½ kneel with upper extremity support
Floor to stand through ½ kneel with hands free
May still have a preferred method of transferring through ½ kneel/ dominant manner of transferring
what is a reflex?
An involuntary response to a stimulus.
Monosynaptic or polysynaptic, short-range or long-range, uni or bilateral, symmetrical or asymm.
Old views: Motor control emerges from reflexes that are nested within hierarchically organized levels of the CNS.
In development, early on lower level reflexes are present, then higher level reflexes/more cortical control develops.
how important are reflexes?
Previously given more focus than we currently do, based on understanding of neuroscience and motor control
Some standardized assessments still use them in determining age-equivalents
Residual presence of one is more telling than the normal emergence and integration of reflexes
You may also may see primitive reflexes with neurological insult later in life
what is the significance of reflexes?
Developmental level and neural functioning could be somewhat explained
Obligatory or persistent reflexes may be indicative of atypical development.
Familiarizes you with the basic developmental model used in medicine and by most pediatricians.
what are the limitations of reflexes?
Motor abilities are influenced by many factors beyond reflex maturation (mechanics, motivation, and environment).
Reflex theories assume CNS as the primary agent of developmental change.
Treatment focused on inhibiting primitive reflexes and promoting higher level reflexes is a narrow view of early intervention.
