Developmental Growth and Mechanics Flashcards
Spine developes
babies born kyphotic
cervical lordisis develop: head lifting
lumbar lordosis develop: extension into lumbar region
–lumbar prone propping, continues with quadruped
LUMBAR LORDOSIS CONTINUES TO INCREASE THROUGH ADOLESCNECE
LE Skeletal Characteristics of Infants
femoral antetorsion
femoral anteversion
femoral coxa valga
shallow acetabulum
genu varum
tibia varum
tibial internal torsion
calcaneal and forefoot varus
metatarsus adductus
Toe in gait, cause?
can happen foot/ankle/femur..
some babies have a lot and as they get older a de-rotation of femur happens because of the WB when they stand muscle pull on the femur: external rotator gluteus maximus
low tone children dont have this de-rotation and have toe in during gait
something in kintetic chain did not allow for the de-rotation
metatarsus adductus
what is it
C shaped foot
tibial varum–how fixes?
bow legged
change with standing when gastroc and soleus work get derotationa t the tibia
HIP at birth
what does it look like
when at most risk for dislocation
at birth –high risk of dislocation
1) shallow acetabulum covering less than 1/2 of the femoral head
2) flat femoral head
3) anterversion
MOST risk for dislocation before 6 months of age
–in combination with Breech presentation
HIP growth
what happens to the acetabulum
compressive forces (WB) deepen the acetabulum up until age 8
Wolf’s Law: muscles pull also influence hip development
—bone will adapt to the loads under which it is placed
-child with SCI who cannot WB (ie spina bifida, spastic quadrapareis a form of CP) cannot deepen the acetabulum
Best position for hips when carrying an infant to prevent hip dysplasia
jockey position = straddle position = frog position
applies force to the acetabulum
–abduction to get the deepening in the acetabulum
—not recommended to hold in adduction if at risk for hip dysplasia (its fine if not)
children with adductor spasticity tone need to be held in abduction
Coxa Valga
what is it
what fixes it
when does it persist
increased angle of inclination or increased neck shaft angle
spontaneously decreases with COMPRESSIVE FORCES: WB and pull of the muscle
if it persists: hip instability
in CP: high adductor tone, not WB: persistent coxa valga, at risk of hip dislocation
(also seen with genu varum)
Antetorsion
decreases from birth through adolescence
femoral head and neck are rotated forward in the saggital plane relative to the axis through the femoral condyle
Anteversion
toe in
refers to the femoral head position in the acetabulum
Femoral bone remodeling occurs until when
-what happens
Femoral bone remodeling occurs until age 8-10 years of age
a lot of de-rotation goes on!!!
the femur untwists through the process of
- -muscle contraction (hip extensors and external rotators)
- -hip flexion contracture decreases
- -coxa valga angle decreases
(we dont like to intervene until this happens)
persistent antertorsion leads to
toe in
ROM
babies have hip and knee flexion contracture, what to do?
at birth babies have a lot of what motions?
why do these values later decrease?
babies have hip and knee flexion contracture: what should we do?
-increased hip abduction, hip external rotation and DF ROM
at birth: babies have a lot of hip ABDUCTION, hip EXTERNAL ROTATION, and ankle DORSIFLEXION: these values decrease as the child moves against gravity
VALUES DECREASES AS UPRIGHT POSTURES ARE ASSUMED: KNEELING STANDING etc.
Physiologic Genu Varum
when is it normal
bow legged
normal until 18-24 months
