Development and Motor Learning

Question 1

How contexts affect development

Answer 1

Cultural: customs, beliefs, behavior standards
Physical: nonhuman aspects of environment
Social: Availability/anticipation of behaviors by others
Personal: Child’s age, gender, eco status, education
Temporal: Stage of life, time of year, length of occ.
Virtual: Communication by means of computers, etc.

Question 2

Gestation

Answer 2

Period of development of fetus in utero and at birth.

Prenatal: before birth (typically 40 weeks)
Perinatal: around birth
Postnatal: post-birth (infant is a neonate)

Question 3

Infancy

Answer 3

Period of development from birth to 18 months.
• Significant physical/emotional growth
• Development of sensory/motor skills (delays can be crucial at this stage)
• Walking, talking, performing self-care tasks (eating from spoon, drinking from cup, undressing)

Question 4

Early Childhood

Answer 4

Period of development from 18 mo. to 5 years.
• Become increasingly independent and develop sense of individuality.
• Fewer developmental milestones.

Question 5

Middle Childhood

Answer 5

Period of development from 6 years to puberty.
• Spend 1/3 of time in educational settings.
• Influence shifts from parents to peers.

Question 6

Adolescence

Answer 6

Period of development from puberty (~12) to 21 yrs.
• Physical and psychological development that accompanies onset of puberty.
• Hormonal changes and resulting challenges.
• Ends with onset of adulthood.

Question 7

Principles of Normal Development:

Answer 7

• Development is sequential and predictable.
• Maturation and experience affect a child’s development.
• Changes occur in the biological, psychological, and social systems.
• Development progresses vertically (levels related to specific skills/occupations) and horizontally (in different performance skills/occupations).

Question 8

3 Basic Rules of Motor Development

Answer 8

1) Cephalocaudal Progression (head to tail) - baby is able to control head/neck, then arms, then trunk, then legs.
2) Proximal to Distal Progression - Children develop control of structures close to body (shoulder) before farther away (hand.
3) Gross to Fine Motor - Children control large body movements before refined movements.

Question 9

Motor Learning (define):

Answer 9

Learning and refinement of motor skills over time.
• Takes place in complex interaction betw child and environment.
• Refers to intrinsic process that accompanies child experiencing and participating in meaningful activities and long-lasting changes in motor performance.
• Based on principles of NEUROPLASTICITY (brain changes and makes new pathways, esp. in children)

Question 10

Neuroplasticity:

Answer 10

The ways the brain changes by laying down new circuitry and making new neural connections.
• Occur when brain receives new info/stimuli
• In response, permanent changes happen in brain
• Learning requires feedback, feedforward, practice, modeling and transfer of learning.

Question 11

Feedback vs. Feedforward

Answer 11

Feedback = Figuring out the activity. Comes AFTER performance of activity. Adjustments made based on performance/reflection.

Feedforward = Ability to plan for activity. Comes BEFORE the performance of activity. Adjustments made based on anticipation of movement required.

Question 12

Principles of Motor Control:

Answer 12

Ability to regulate or direct the mechanisms essential to movement.
• Role of CNS, techniques to quantify movement, nature and quality of movement
• Addresses posture, mobility, and fine motor and gross motor skills; explores motor dev. throughout lifespan
• Supports DYNAMIC SYSTEMS approach.

Question 13

Motor Control (define):

Answer 13

Ability to regulate or direct the mechanisms essential to movement.

Question 14

Dynamic Systems Theory

Answer 14

Interplay betw neuromuscular system, environment, cognition, and the intended task.
• Change in one system affects the others.
• One task involves dynamic interaction of many systems (visual, proprio, tactile, etc.)
• To engage, one must have intent to move (guided by cognitive process)
• Change leads to neuroplasticity.

Question 15

3 Pillars of Motor Control

Answer 15

Can be a ven diagram. Interventions for children are:

1) Meaningful (children engage more in meaningful tasks)
2) Closely Mimic Occupations of Childhood
3) Occur in Natural Context (setting similar to natural place where occ happens)

Question 16

Feedback

Answer 16

Feedback = Results.
• Informs about progress in acquiring new skills.
• Before (feedforward) and after (feedback) performance.
• Intrinsic (within the child)
• Extrinsic (provided by external source)
• Verbal and nonverbal
• Consider type, timing, motor outcomes.

Question 17

Intrinsic vs. Extrinsic Feedback

Answer 17

Intrinsic: info the child received following a practice attempt (internal; nervous system processes).

Extrinsic: provided by others, or even by activity itself; helpful in identifying errors in movement. *Children respond to consistent ext. feedback with learning new skill, and it becomes internalized with practice.

Question 18

Timing of Feedback

Answer 18

May be provided in various ways:
• Concurrent: during movement.
• Immediate: following movement.
• Terminal: right at completion of movement
• Delayed: after movement completed and time has transpired.
• Sporadic*: following some but not every trial; found to be more beneficial.

Question 19

Modeling or Demonstration

Answer 19

Modeling = Just watching someone do it.
Demonstration = Instruction provided while watching.

• Visual information on how to perform a task/skill.
• Most effective when presented in natural context.
• Demos best if provided:
- Before practicing and in early stages of learning;
- Slowly, without verbal feedback;
- After emphasizing critical cues;
- Throughout practice as frequently as is helpful.

Question 20

Verbal Instruction

Answer 20

• Can be used to teach children motor skill
• Only as successful as instruction is detailed!
• Practice is preceded or accompanied by verbal instruction or cues (brief, 1-3 words)
• Once child completes key components, OT may provide addtl verbal instruction to refine movement
• Providing repetitive practice w/same verbal instruction reinforces learning.

Question 21

Knowledge of Results vs. Knowledge of Performance

Answer 21

Knowledge of Results (KR): Info provided from external source about outcome or end result. Helps children retain newly learned motor skills.

Knowledge of Performance: Providing info about nature or characteristic of the movement. Helps children understand how they could adjust or change movements.

Question 22

Types of Practice

Answer 22

Blocked Practice: Repeating similar movements with short rest breaks.

Distributed: Repetition of different skills spread over course of intervention with rest breaks.

Variable/Random: Practice of many different skills with periods of rest.

• ** Practicing PERFECT makes perfect!
• ** Repetition of motor tasks enhances brain development.

Question 23

Transfer of Learning/Generalization

Answer 23

Applying past learning to new situations.
• Works best when client has opportunity for mastery of foundational skills first.
• Then, incorporate different/new skills.

Question 24

Motor Memory

Answer 24

Registration of influence and internal feedback from the motor output back into the sensory system.
• After the motor/sensory link is when learning occurs.
• “Automatizing” the skill.
• Motor control best addressed by engaging child in meaningful activities closely mimicking occupations of childhood and occur in natural context. (ex: Char’s story of teaching her grandson to tie his shoe with “middle finger” which is a playground gag.)

Question 25

Degrees of Freedom

Answer 25

Child may have difficulty controlling movements due to joints varying in amount of movement. Must learn to control shoulder, elbow, wrist before hand joints. Proximal to distal motor learning. • To increase control, degrees of freedom can be limited by holding/stabilizing joint(s).

Question 26

Coordination

Answer 26

Activation of specific muscles together. • May be addressed by beginning with gross movements and progressing to more precise. • Also address by encouraging postural stability during tasks.

Question 27

Timing

Answer 27

Ability to time movements when needed. | • Can be promoted by including music, rhythmic songs, or counting.

Question 28

Strength

Answer 28

Ability to contract a muscle/muscle group against gravity and resistance. Can be changed/improved. (NOT tone!) • Children with motor deficits may have decreased strength/endurance, impacting occ participation.

Question 29

Muscle Tone

Answer 29

Amount of tension in resting muscle or muscle group. Cannot be changed/improved. (NOT strength!) • Discrepancies interfere with occupations • OT may focus on helping child engage, allow him to refine motor skills

Question 30

Physiologic Flexion

Answer 30

Noenate posture due to position in utero. Passive stretching of exterior muscles of trunk during last trimester of pregnancy. Elongation of the neck and trunk extensors prepare for moving against gravity after birth (controlling neck extension/head lifting).

Question 31

Benefits of symmetrical alignment/positioning

Answer 31

* Helps develop postural stability * Each side of body develops equal muscle strength * Helps maintain full ROM for movement and efficient limb movement * Helps bring hands to midline and couple visual system with hand use * Engages upper and lower body together * Provides physical comfort, reduces fatigue

Question 32

Stability vs. Mobility

Answer 32

Stability and mobility lead to control of movement. Mobility is present in infants before stability. STABILITY = ability to maintain a posture. MOBILITY = ability to move into or assume a posture.

Question 33

Righting vs. Equilibrium Reactions

Answer 33

Righting Reactions = support midline postures and bring head back in alignment with body (ie: rolling toward toy while keeping head in line with body) Equilibrium Reactions = help maintain body alignment and balance when center of mass is shifted too far over base of support (ie: adjusting posture to prevent a fall)

Question 34

Protective Extension

Answer 34

Occurs when body’s center of gravity is shifted too far off base of support and righting/equilibrium reactions cannot correct. This is when arms/legs extend to prevent a fall. 6-9 months through life.

Question 35

Principles of positioning children as therapy:

Answer 35

* Provide variety of postions thru day * Use positions that enhance function for specific activities * Avoid positions that restrict ability to move purposefully * Provide positions that are comfortable * Consider safety (ie: do not leave unattended in positioning device) * Ensure skeletal alignment and body symmetry * Recommend positioning equip that provides external trunk stability to facilitate movement * Assure caregivers are trained on use of positioning equip.

Question 36

Prone vs. Supine Position in infants

Answer 36

PRONE: neck and trunk extension, building muscle strength/stability in neck, upper back, shoulders, arms and hands. Lengthens hip flexors, helps develop rib cage, and higher-level motor like crawling. SUPINE: Further develops neck/ abdominal muscle control, which allows bringing head, hands and feet to midline, awareness of body and visual-motor coupling. Promote keeping head at midline/flexed slightly for best vision use.

Question 37

Typical age to assume unsupported seated position

Answer 37

6 to 7 months; must control head, trunk and extremities against gravity and coactivate trunk muscles.

Question 38

Seated positions for children

Answer 38

Long-sitting: cross-legged Ring-sitting: feet together, knees out to sides (cobbler pose) Tailor-sitting: legs straight out in front Side-sitting: knees flexed, both legs to one side W-sitting: legs to sides, rotated inward, forming a “w” shape. (*Stable while developing, but not encouraged after 1 y.o.)

Question 39

Basic sitting position guidelines:

Answer 39

* hips and knees flexed to 90˚ * back against chair back * vertical trunk * symmetric body * head aligned with trunk, at midline, flexed slightly forward * all 3 back curves present/in alignment (use lumbar roll if needed) * both feet flat on floor/supported on raised surface in neutral * tabletop or lapboard at elbow height. Elbows flexed at 90˚ to armrests, if available

Question 40

Neurodevelopmental Treatment (NDT)

Answer 40

Problem-solving approach to examination and treatment of impairments and functional limitations of individuals with neuropathology, primarily children with CP. • Goal is to help perform skilled movements more efficiently for life skills, and for child to perform movement actively (themselves) • Understanding typical movements to analyze/treat abnormalities • Facilitate normal movement patterns so child “feels” typical movement and learns it • Target postural control by using key points of control (proximal or distal) • Learning through repetition and refinement

Question 41

Sequence of Acquiring Prewriting Strokes

Answer 41

* 1-2 years: scribble/circular scribble * 2-3 years: vertical/horizontal strokes then lines * 3-4 years: circles and intersecting strokes/lines * 4-6 years: diagonal lines and ability to form shapes (ie: triangle, square)

Question 42

Two most mature grasp patterns (writing)

Answer 42

1) Dynamic Tripod Grasp: 3 fingers used to hold utensil. Bent thumb and index point to tip, utensil rests on middle finger. 2) Lateral Tripod Grasp: 3 fingers, index points to tip, utensil rests on bent inward middle finger, however the thumb crosses perpendicularly over index finger.

Question 43

Domains of Development

Answer 43

* Physiologic * Motor * Cognitive * Language * Psychosocial

Question 44

OTPF Performance Skills

Answer 44

* Motor Skills (Fine/Gross Motor) * Process Skills (Cognition) * Social Interaction Skills (Language/Psychosocial) * Disruptions in any of these may interfere with child’s performance in occupations.

Question 45

Infant Physiologic Development

Answer 45

* Neonate average size: 7lb 2oz / 19-22 in. * Appearance at birth: layer of fluid (vernix caseosa); large bumpy head; broad nose; reddish skin; puffy eyes; external breasts; fine hair (lanugo) over body * APGAR score given at 1 minute after birth

Question 46

APGAR Score

Answer 46

``` Test given 1 minute after birth. Scores 0-2 on: • Color • Heartrate • Reflex irritability • Muscle tone • Respiratory effort ```

Question 47

Brazelton’s Behavioral States

Answer 47

6 states observed in a newborn should be noted when observing response to stimuli: 1) Deep sleep 2) Light sleep 3) Drowsy/semi-dozing 4) Alert, actively awake 5) Fussy 6) Crying

Question 48

Tummy Time

Answer 48

* Physiologic flexion raises pelvis off floor, moving weight to head/shoulders * While prone, positions hands beside cheeks * When turning head, rooting reflex on cheeks * Suck on hands; develop oral motor * Raising head in prone puts pressure on ulnar surface, facilitating grasping * Weight-shift in prone puts pressure on radial surface, leading to more mature grasp

Question 49

Piaget’s Four Stages of Cognitive Development

Answer 49

1) Sensorimotor* 2) Preoperational 3) Concrete Operational 4) Formal Operational *Infants develop ability to organize and coordinate sensations with physical movement and actions during first stage.

Question 50

Six Substages of Sensorimotor Stage

Answer 50

1) Reflexive: reflexes such as sucking/palmar grasp 2) Primary Circular Reactions: repeats reflexive movements for pleasure 3) Secondary Circular Reactions: use of voluntary movements to repeat actions that accidentally produced a desired result 4) Coordination of Secondary Schemata: combines previously learned schemes and generalizes them 5) Tertiary Circular Reactions: repeatedly attempts task, modifies behavior to achieve desired consequence 6) Inventions of New Means Through Mental Combinations: uses trial and error to solve problems

Question 51

Ainsworth’s Four Stages of Attachment

Answer 51

1) 2-3 mo., initial attachment (non-discriminating) 2) 4-6 mo., attachment in the making (discriminates familiar/unfamiliar) 3) 6-7 mo., clear-cut or active attachment (attaches to one primary caregiver) 4) After 12 mo., multiple attachments form

Question 52

Greenspan’s Stages of Psychosocial Development

Answer 52

* Self-Regulation and Interest in the World (parent regulates internal/external world) * Falling in Love (child forms strong attachment to caregiver) * Purposeful Communication (smiling is purposeful/gets response from adults) * Organized Sense of Self (realization of how behaviors can be used for reactions)

Question 53

Adolescent Egocentrism

Answer 53

* Believe that others have similar thoughts to theirs * “Imaginary audiences”: perception that everyone is watching * “Personal fable”: idea that they are special, have completely unique experiences

Question 54

Adolescence and Identity

Answer 54

• Main goal is to find/understand identity • Combines past experiences with future expectations • Explores various occupations, develops work habits, identity as worker PEERS: • Opportunities to share, learn from others • Experiment with new ways of handling situations • Try out new roles

Question 55

Stagger Reflex

Answer 55

Taking 1+ steps in direction of displacement; UEs often also extend as protective reflex. 15-18 months through life.

Question 56

Standing Reflex

Answer 56

Head-righting when pulled to side; standing upright, extremities relaxed. 12-21 months through life.

Question 57

Tilting Reaction

Answer 57

Head tilts to right itself as body position changes. (??)

Question 58

Primitive Reflexes

Answer 58

Rooting (birth-3 mo.); baby’s head turns in direction of facial stimuli. Sucking (birth-2-5mo.); touch on oral cavity causes sucking/swallowing. Neonatal Positive Support (birth-1-2 mo.); lying supine with head to one side, limbs on face side extend, limbs on skull side flex/increase tone.

Question 59

Infant Primitive Reflexes of Neck

Answer 59

(All are birth to 4-6 mo.) ATNR (asymmetrical tonic neck reflex) = Arms/legs flex/extend in quadruped position (crawl reflex). STNR (symmetrical tonic neck reflex) = Tone of neck and extremities increases when body moved from supine, limbs extended to flexing. TLR (tonic labyrinthine reflex) = Arms extend/hands open then arms flex/hands close when head drops in supine position. (Baby usually cries.)

Question 60

Moro’s vs. Landau Protective Reflexes

Answer 60

Moro’s = Birth to 4-6 mo.; Extremities abduct then adduct, then baby usually cries. Reaction to sudden loss of support. Landau = 3-4 mo. to 12-24 mo.; When head moves suddenly toward floor, arms flex/extend toward floor to protect head. When held prone, head extends and legs flex.

Question 61

Cerebellum

Answer 61

Part of the brain responsible for successful execution of smooth movement. Controls speed of movement, and makes adjustments (for example, writing at appropriate size). Monitors position of body to keep one balanced in postures of movement. Role in learning sequences to complete motor tasks, esp with dexterity/speed.

Question 62

Frontal Lobe

Answer 62

Part of brain that houses personality, judgment, insight and motor control.

Question 63

Protective Extension Reaction

Answer 63

When righting and equilibrium do not retain upright posture quickly, this reflex to reach outward to catch yourself/break fall is a protective response requiring strength to support body's weight while bracing.

Question 64

Blocked Practice

Answer 64

Type of intervention when client does activity, rests briefly, then repeats activity again.

Question 65

Motor Control Theory

Answer 65

* Use of meaningful activities to encourage repetition and increase motor performance * Design meaningful interventions to maximize child's involvement, volition, and engagement * Activities closely mimic occupations of childhood as both the goal and the means to achieve the goal * Allow child to adapt, problem solve, and respond within NATURAL CONTEXT * Allow child to make MISTAKES and self-correct to create motor solutions.

Question 66

Temporal Context

Answer 66

Includes a child's stage of development when considering tasks or goals associated with the child.

Question 67

Horizontal Development

Answer 67

Simultaneously learning different performance skills/areas together (such as ADLs, fine motor skills, gross motor skills, etc.); example: child learning to finger-feed while learning pincer grasp.

Question 68

Variable Practice

Answer 68

* Most effective type of practice for transfer of learning. * Incorporates practicing of many different skills with periods of rest. * Helpful for fine-tuning of skills. * Variety of movements means better movement quality attained.

Question 69

Typical developmental sequence of acquisition of gross motor skills

Answer 69

1) Physiological flexion 2) Rolls from supine to prone 3) Complete head control 4) Creeps 5) Stands alone