Development Flashcards
Normal, Atypical and Premature Infants
what are the basic tenants of Maturational Theory?
- development occurs in a cephalocaudal direction
- development occurs in a proximal-distal direction
- development of one motor skill leads to the development of another
- motor milestones are invariant in their sequence
- motor skills develop from gross to fine
- motor skills progresses from reflexive to voluntary
- total response before localized response
- cephalic control before caudal control
what is the dynamic systems theory?
holistic approach to understanding human motor development
assumes that the individual functions as a complex, dynamic system comprising many subsystems and that there is an innate organization that occurs between complex particles that is directed by no one system
Kinesiology Concepts NDT
- Physiologic flexion
- Antigravity extension
- Antigravity flexion
- Lateral flexion
- Rotation
- Asymmetry
- Symmetry
- Controlled asymmetry
Kinesiology concepts NDT → rotation-dissociation
- rotation requires balanced control of flexion and extension and dissociation between body segments
- dissociation is the breaking up of the mass pattern, it is the ability to separate movement in one body part from associated movement in another
- examples
- eyes-head
- head-trunk
- hand-elbow
what is gestation?
a period of time during which an embryo develops in the mother’s womb
- most radical change in human existence
- a single cell grows into a complex and functional human being within 37-42 weeks
- divided into 3 periods
what are the 3 periods of gestation?
- First trimester → weeks 1-12
- all major body systems are established
- Second trimester → weeks 13-26
- body proportions grow to newborn proportions
- Third trimester → weeks 27-40
- body weight triples and body length doubles
- body fat accumulates which aids in body temp regulation
- at 36 weeks, lungs are developed
describe early prenatal movement
- fetal movement is seen around 7-8 weeks gestation
- at 9 weeks, some jerky, startle type movement
- there are both gross and fine movements, random and coordinated patterns
- fetal movements may have the purpose of preventing stasis and adhesions and preparing the fetus for birth
T/F: fetal movements may have diagnostic or predictive value
TRUE
the quality of fetal movement provides an indicator of the chronic neurological condition of the fetus
list some atypical development characteristics
- abnormal tone
- exaggerated, prolonged reflex behavior
- absense of normal reflexes
- flexion and extension are not balanced
- persistence of asymmetry
- Lack of:
- variability, variety, and frequency of spontaneous movement
- adaptability
- antigravity control
- dissociation, rotation
- controlled weight shifts
- elongation on WBing side w/lateral flexion on WBing side
- poor proximal stability w/decreased ability to move against gravity
- prolonged fixing or limiting DOF due to poor underlying control
- abnormal postural alignment
- poor coordination and control of movement
what is considered a premature birth?
less than 38 weeks
describe the physiologic characteristics of a newborn
- head proportionally larger with short LEs
- kyphotic, horizontal ribs
- ROM differences:
- excessive DF
- 30º flexion contractures at hips and knees
- Physiological flexion
newborn positions
- supine
- prone
- supported sit
newborn characteristics in supine
- head rotated
- rooting reflex
- neonatal neck righting
newborn characteristics in supported sit
- fleeting attempts to lift head
- back rounded but pelvis perpendicular
newborn characteristics in prone
- weight bearing through upper trunk, shoulders, head
- lifts head to clear airway
Newborn UE positioning
- hands open as arms abduct
- hand movement related to arm movement
- strong grasp but hand loosely flexed at rest
- resting posture - slight shoulder adduction, elbow flexion, elbow pronation
Newborn LE positioning
- vigorous, rhythmical reciprocal kicking
- automatic standing and stepping
- biomechanical aspects:
- medial femoral torsion
- femoral anteversion
- femoral bowing
- femoral coxz
- valga
- shallow acetabulum
- genu varum
- tibia varum
- tibial torsion
- calcaneal varus
- forefoot varus
- occassional metatarsal adductus
newborn vision
- easiest to fixate on a moving object Laterally and Vertically
- prefer strong constrasts
- best at 8-9 inches away
describe the physiologic characteristics of 1-2 month year old
- decrease in physiologic flexion
- relative hypotonia and asymmetry
- beginning of active postural control
- increased alertness and visual awareness
- more purposeful head movement
1-2 month positions
- prone
- supine
- supported sit
- supported stand
1-2 month characteristics in prone
- better head lift → momentarily to 45º
- elbows behind shoulders
- increased head/neck extensors muscles with less WS forward on the face and shoulders
- decreased hip flexion
1-2 month characteristics in supine
- increased cervical rotation with movement of extremities away from the body
- ATNR may appear
- head rarely in midline
1-2 months characteristics in supported sit
- begin to see scapular adduction to assit with head lift
- during pull to sit
- head lags but may see grasp reflex
- traction response with elbow flexion
1-2 months characteristics in supported standing
- Atasia abasia
- motor incoordination for standing and walking
1-2 month UE positioning
- swiping in supine
- grasp reflex decreased
- may voluntarily retain object placed in hand for brief period
- bilateral scapular retraction and spinal extension provide synergistic stability for head lifting
1-2 month LE characteristics
- kicking may be bilateral and symmetrical, feet come together
describe the physiologic characteristics of a 3 month year old
- alert and aware
- interacts visually with caregivers
- symmetry and midline orientation beginning
- marked increased in bilateral symmetrical activity and antigravity flexor control
3 month positions
- prone
- supine
- supported to sit
- pull to sit
- standing
- ability to track 180º w/head extended and eye hand regard
3 month characteristics in prone
- sustains prone on elbows with head elevated 45-90º in midline
- rotated head while elevated subtle weight shifts
- increased caudal weight shift → lumbar extensors help stabilize thorax
3 month characteristics in supine
- symmetry and midline become dominant
- chin tuck → bilateral control of capital and cervical flexor muscles
- capital flexion elongates capital and cervical extensors
- foot to foot play
- increased active knee extension accompanied by hip extension and adduction, but also decreased hip ER
3 month characteristics in supported sit and pull to sit
- supported sit → sustained head lift
- pull to sit → head rights midway
3 month characteristics in standing
- Atasia abasia usually gone
- able to sustain head lift
- scapular adduction
- toe curling
- plantar grasp reflex
- WBing on medial side of foot
describe the physiologic characteristics of a 4 month year old
- beginning of controlled purposeful movements and alternating, coordinated movements
- easily alternate between flexion and extension in supine and prone
- visual tracking w/o head turning
- development of downward visual gaze
4 month positions
- prone
- supine
- sidelying
4 month characteristics in prone
- head extended at 90º
- pivot prone
- prone on extended UE
- Landau
- increased lordosis
- able to flex head w/o collapsing
- increased activity of adductors, erector spinae and horizontal obliques
- ribs less horizontal
- weight on forearms, pecs more active and begin to balance extension
4 month characteristics in supine
- increased hip extension and adduction
- alternates between pelvic anterior and posterior tilting
- important development of trunk synergistic activity for LE movements
- hands to knees and other body parts
- begin to see ankle PF, INV/EV
4 month UE characteristics
- reach in supine with forearm pronation, wrist extension
- primitive ulnar grasp and squeezing pattern
- can bring hands together but not yet transfer
- cannot release with control
- shakes and bangs, mouth objects
what is significant about a 4 month year old shaking and banging objects with arms and putting things in their mouth?
important for perceptual awareness of shapes and sizes and textures and in decreasing tongue and mouth sensitivity
4 month characteristics in sidelying
- baby may roll from supine with hands on knees
- initiated with head rotation and symmetrical flexion
- sidelying is important in rib cage shaping
- provides new visual and vestibular orientation
- angulation of rib cage important for respiration, phonation, trunk and rib cage mobility
describe the physiologic characteristics of a 5 month year old
- voluntary asymmetrical, dissociated, and reciprocal movements
- balance of flexion and extension with emergence of lateral flexion
- increased spinal mobility
- basis for body RR
- equilibrium reactions
- diagonal movements
5 month characteristics in prone
- lateral weight shift in POE
- frees face side hand for reach, LEs
- may push up on hands
- rolls to supine
5 month characteristics in supine
- feet to mouth
- flexes head if hand held
- rolls to side
5 month characteristics in supported sitting and sidelying
- supported sitting
- ring sits
- props on hands
- sidelying
- first symmetrical then asymmetrical
- momentary lateral flexion of head
5 month UE characteristics
- palmar grasp
- occasionally manipulates and transfers
- brings toy to mouth rather than mouth to toy
- grabs, mouths, bangs, shakes toys
describe the physiologic characteristics of a 6 month year old
- more active, uses less positional stability
- good head control in flexion, extension, lateral flexion
- LEs gain extensor control
- beginning to respond to diagonal WS with rotation
- independent sitting
6 month characteristics in supine
- lifts head
- activity of capital and cervical flexors with synergistic activity of abdominals to stabilize the thorax
- legs extend with PTS
- rolls to prone
- lots of playing w/feet in air
6 month characteristics in prone
- mature landau but extension balanced with flexion
- head-neck extension balanced with flexion
- chin tucked with elongation of extensors
- prone on extended arms, pivoting
- pushing backwards, may assume quadruped
6 month characteristics during rolling from supine to prone
- initated with flexion
- transitions to extension in sidelying
6 month characteristics in sitting
- positional stability of legs
- protective extension forwards
6 month characteristics with head rotation
WS occurs to the same side as head turns
may cause the baby to fall
6 month characteristics during standing
- sufficient hip and trunk control to indpendently hold on to the support of a person
- may bounce
- legs abducted
6 month characteristics of UEs
- increased abdominal control provides synergistic stabilization to the thorax during humeral movements
- SA provides stabilization for the scapula
- rotator cuff, deltoid and pec major dynamically stabilize the humerus for reaching
- can stop humerus movement midstream
- more precise reaching
- cross midline
- isolate elbow movements
- forearm still pronated, some supination in combo with shoulder ER
- palmar and radial palmar grasp
6 month characteristics of LEs
- Hips more adducted with less ER
- LEs prone to lateral WS with dissociation
- In prone
- WB side extends, adducts, IR to neutral
- nonWB side flexes and rotates backward (opposite response in sitting)
- Importance of hip IR and elongation of hip abductors for WS
describe the physiologic characteristics of a 7 month year old
- variety of movement
- more incentive, desire, and capability to move into environment
-
transitions from quad to sit
- requires marked mobility at hip joints as femurs move under pelvis, and dynamic trunk-pelvic stability
- assumption of quad from prone
- lordosis in quad with hips abducted
- may assume bear standing
7 month characteristics in sitting
- Sitting → assumed from quad
- able to rotate trunk
- legs abducted and ER
- trunk straight, may see slight lordosis
- arms free for play
- protective extension sideways
7 month characteristics during pull to stand
- at first sing a symmetrical pattern and then half kneeling
describe the physiologic characteristics of an 8 month old
- preferred position for play
- creeping for mobility
- may begin climbing on furniture, stairs
- increased interest in small objects
- play in kneeling
- rely on UE for stability
- hips and knees flexed
- ankles DF
8 month characteristics in sitting
- trunk and pelvic-femoral muscles provide sufficient stability to play with different LE positions
- progress to long sit, half sit, side sit
8 month characteristics in quadruped
- beginning of equilibrium
- crawing reciprocal extremity movements require counter rotation, diagonal control
- combo of lateral WS, LE dissociation, diagonal trunk control
8 month characteristics during climbing
- indication of problem solving
- how to manipulate body on unfamiliar, uneven, unsteady surfaces
8 month characteristics in standing
- still need the UEs to stabilize the posture
- LEs abducted
- may release one hand and reach out in space
- rotation of trunk over stable pelvis and extended LEs
- may lower to floor from standing
- how low they get before falling is an indicator of eccentric quad control
8 month characteristics for cruising and walking
- cruising sideways, body facing forward
- walk with hand-held
- steppage gait (hips flexed, abducted, ER during swing)
- leads by leaning trunk forward, does not yet use active lower trunk,
- LE WS
- hip in line w/body in standing due to lordosis, hip extension still incomplete
describe the physiologic characteristics of a 9 month old
- variety, versatility
- good trunk control
- strong desire to stand and walk
- more refined cruising - hip abducts with less hip flexion and more knee extension
- increased control of hip abd/add
- closer alignment of LE with trunk during single limb WB
- independent kneeling w/more active hip extension
- LEs more active during pull to stand
- cruising
- semi turn towards direction moving
10 month olds are ___________
busy, active, exploring
8 month UE characteristics
- container play
- in/out, practicing release
- 3-jaw chuck, pincer
- mimics gestures
- reaching across midline
8 month cruising and walking characteristics
- triplanar motion of hips, may cross open spaces
- cruises around corners
- perceptual challenges
- motor planning
- cruises around different height, texture, and firmness of objects
- supported walking
- scapula adducted
- trunk extended
- anterior pelvic tilt
8 month standing characteristics
- increased ankle movement in standing
- more activity of gastroc
- PF and INV calcaneus
- toe standing
11 month characteristics
- stands alone when absorbed in a task
- walks with one hand held
- assumes standing (quad-semi half kneel-squat-stand)
- squatting → weight posterior with minimal ankle DF
- hip extensors, abdominals, quads, and ankle DF work in synergy
- rise to stand
- symmetrical extension at hips and knees while ankles stabilize
- may see regression in postural control with attempts at independent walking
- UE
- more control of release, neat pincer
12 month characteristics
- basic motor skills present
- independent standing
- wide BOS
- may begin to use hands more
- increased LE dissociation, greater skill in planning, organizing and executing climbing activities
- most walk independently
Motor signs of motor disorders can be generally classified in what 2 categories?
- Positive signs
- Negative signs
what are positive signs of motor disorders?
signs that lead to increased frequency or magnitude of muscle activity, movement, or movement patterns
examples
- hypertonia
- chorea
- tics
- tremor
what are negative signs of motor disorders
insufficient muscle activity or insufficient control of muscle activity
examples
- weakness
- impaired selective motor control
- ataxia
- apraxia
are negative or positive signs easier to detect in clinic?
- negative motor signs may be even more significant contributors to disability than positive signs
- positive and negative motor signs are often simultaneously present and may be linked rather than indpendent features of a motor disorder
describe the negative sign: weakness
- insufficient muscle activation, inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint
- assessed during attempts to generate force in a single joint at one point in time
- can occur in the presence of hypertonia, hyperkinetic disorders, or other involuntary movements
how can weakness be masked?
- by the fact that a muscle with spasticity, dystonia, or rigidity may resist passive movement by the examiner
- by the apperance of significant active but involuntary joint extension torque resulting from dystonia
describe the negative sign: reduced selective motor control
- defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of voluntary postures or movements
- the expected pattern is not achieved either due to excessive activation of muscles that would be expected to be relaxed or inability to activate muscles that would be expected to be active
give some examples of reduced selective motor control
- activation of knee and hip flexors muscles when a child attempts to dorsiflex the ankle
- these patterns are sometimes referred to as “obligate synergies”
- reduced selective motor control may manifest as abnormal postures or unusual movement patterns
- the child may have to adduct the shoulder in order to generate sufficient elbow extension force
describe the negative sign: ataxia
- defined as inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints
- trajectory is a series of positions or joint angles over time
- in some cases, may lead to decreased accuracy
specific deficits that may be seen as components of ataxia include:
- dysmetria (inaccurate motion to a target)
- dyssnergia (decomposition of multijoint movements)
- dysdiadochokinesia (lack of rhythmicity)
what is apraxia?
impaired ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity
what is developmental dyspraxia
failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness or involuntary motor activity
what are complex motor actions?
refer to actions that may have multiple components and are associated with goal-oriented task performance, tool use, or gestures
what are other negative signs in childhood?
- deficits in sensory function including tactile, kinesthetic, or proprioceptive sensation
- sensory information and attention are needed to correct for errors during movement and to determine errors in the outcome
- deficits in higher-order sensory function may impair the ability to determine spatial relationships between objects therefore can interfere with tool use, bimanual coordination or task planning
what are signs that may assist in an early diagnosis of neuromotor dysfunction?
- altered muscle tone
- discrepancies between proximal and distal muscle tone
- delayed milestones
- prolonged fixation at a given stage
what are soft signs of neuromotor dysfunction?
refers to a group of functional neurological findings which are general and not focal, often subtle, and may relate to faulty integration in abnormal development
they may give clues to underlying poor organization and possible CNS deficit
list some behavioral soft signs
- sucking, swallowing and feeding abnormalities
- colic
- persistent irritability
- demanding behavior
- continuous gross movement and activity
- markedly limited attention span
- delayed speech with poor or repetitive expression
- withdrawn and isolated behavior
- irregular sleep habits
- repetitive movements
early differential diagnosis features of CP
- History
- soft signs → often positive colic: irritable, sleep problems
- milestones → delayed
- Physical exam → delayed growth
- Neuro Exam
- tone → increased/decreased
- reflex behavior → persistent primitive, delayed postural
early differential diagnosis features of Intellectual Deficit
- History
- soft signs → generally negative “easy baby”
- milestones → delayed
- Physical exam
- Neuro exam
- tone → hypotonia
- reflex behavior → normal disapperance of primative, delayed postural
early differential diagnosis features of ADHD
- History
- Soft signs → possible genetic active, demanding, colic, sleep problems
- milestones → advanced motor, delayed speech
- Physical exam
- Neuro Exam
- tone → normal
- reflex behavior → normal disappearance of primitive reflexes, early apperance of postural
how many hospital perinatal care levels are there?
4 levels
describe the 4 levels of hospital perinatal care
- Level I → well-baby nursery
- Level II → special-care nursery
- babies born less than 32 weeks and weighing less than 1500g
- mechanical ventilation for brief period
- Level III → NICU
- sustained life support
- full range of medical specialities
- advanced imaging
- Level IV → regional NICU
- surgery for complex conditions
children born at less than 37 weeks gestational age and with VLBW are ________
30% more likely to develop CP, ID, RDS, BPD, ROP, HI
list characteristics of a premature baby
- hypotonia
- decreased ratio of type I to type II
- this results in muscular fatigue → particularly respiratory muscles
- incomplete ossification of bones, ligamentous laxity
- results in greater effects of positioning and gravity
- more reactive to sensory stimuli
evolution of sensory responses
touch
movement
smell and taste
hearing
sight
describe the vestibular system in babies
- mature in the full-term newborn
- modifications with development due to synapses and dendrites
- think of the vestibular stimuli provided in the womb as compared to the NICU
- vestibular stimulation is known to enhance behavioral states
describe the olfactory and gustatory development in newborns
- olfactory development begins at 5 weeks gestation
- the ability to smell begins at 28 weeks
- taste buds begin to mature at approximately 13 weeks
- the fetus experiences a variety of taste and smells in utero
describe the auditory system in newborns
- by 24 weeks’ gestation, cochlea and peripheral sensory end organs are developed but the pathways continue to mature
- the premie is exposed to NICU noise that may cause cochlear damage, sleep disturbances, and disturbed growth and development
- the NICU has updated this
describe the visual system in newborn
- vision is the least mature at term birth
- from 24 weeks to term, the retina and visual cortex undergo extensive maturation and differentiation
- by 34 weeks, pupillary reflex present, may see brief eye opening and fixation on a high contrast from under low illumination
- by 36 weeks, saccadic visual following horizontally and vertically
- at term, vision is 20/400
