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Pediatrics > Developmental Milestones - Postural Control, Reach & Grasp, Mobility > Flashcards

Developmental Milestones - Postural Control, Reach & Grasp, Mobility Flashcards

1
Q

Limiting factor on the emergence of other behaviors and inhibition of reflexes

A

postural control

delayed or abnormal development may constrain a child’s ability to develop independence in mobility & manipulatory skills

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2
Q

Postural Control

  • what systems are involved
  • 7 things that leads to control
A

Primarily a complex interaction between MS and neurological systems

  1. MS components
  2. Internal representations (proprioception)
  3. Adaptive mechanisms (learned movements, reactions to perturbations)
  4. Anticipatory mechanisms (feedforward)
  5. Sensory strategies
  6. Individual sensory systems (visual, vestibular)
  7. Neuro-muscular synergies
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3
Q

Postural reactions

  • what are they (3 goals)
  • when do they appear, disappear
  • overview of 3 types
A

automatic responses to sensory input to…

  1. keep body parts in alignment
  2. maintain equilibrium
  3. Prevent injury

Appear between 2-18 months & persist throughout life

3 types: righting reactions (vertical & rotational), equilibrium (tilting & postural) and protective

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4
Q

Righting Reactions

  • what is the goal
  • two types
A

Goal/purpose: orient the head to vertical OR restore body parts to normal alignment following rotation

Vertical Righting - onset birth-2 mo
- optical righting & labrynthine righting

Rotational Righting - onset 4-6 mo

  • Neck righting on body (NROB)
  • Body righting on body (BROB)
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5
Q

Vertical Righting

- Optical & Labrynthine

A

Righting reactions - subsets w/n postural reactions that are present throughout life

Onset - birth to 2 mo

Optical - Tip body in any direction and their head will right to vertical
Labrynthine - occlude vision, tip body in any direction and their head will right to vertical

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6
Q

Rotational Righting

- NROB & BROB

A

Righting reactions - subset w/n postural reactions that are present throughout life

Onset 4-6 months

NROB - turn head to one side and the body will log roll (usually disappears after 12 months)
BROB - rotate one body segment and the body will roll segmentally (MATURE response)

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7
Q

Equilibrium Reactions

  • what are they
  • two types
A

total body responses - postural reactions

Tilting Reactions & Postural fixation

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8
Q

Tilting Reactions

  • what is it
  • onset
A

This is an equilibrium reaction (subset of postural reaction)

movements on an UNSTABLE BOS, the support surface moves under the body

Prone (6 mo), Supine & sitting (7-8 mo)

Child is tilted laterally, they will have spinal concavity and ext/abd of libs on the elevated side w/ rotation of head and upper trunk toward midline
- protective extension downward may occur

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9
Q

Postural fixation

  • what is it
  • onset
A

This is an equilibrium reaction (subset of postural reaction)

movements are on a STABLE BOS, the body moves over the support surface

Quadruped (9-12 mo), and standing (12-21 mo)

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10
Q

Protective Reactions

  • what is it
  • 4 of them… w/ onset
A

subset of postural reactions

extension of the limbs when the balance is challenged

  1. Downward - onset 4 mo - ext/abd of legs
  2. Forward - onset 6-7 mo - ext/abd of arms
  3. Sideways (in sitting) - onset 7 mo - ext of one arm in the direction of the force
  4. Backward (in sitting) - 9-10 mo - ext of both arms back
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11
Q

Reactive Postural Adjustments (RPA’s) and Anticipatory Postural Adjustments (APA’s)

  • what are they
  • when do they emerge
A

RPA’s - appropriate muscle activation in RESPONSE to perturbation

APA’s - cognitive process for predicting postural requirements and selecting timely anticipatory motor strategies;
- APA’s are LEARNED

both of these emerge in parallel w/ development of motor milestones and control

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12
Q

Postural Control & sway from neonate to new walkers

A

3 days post-natal - postural response of head in supported sitting

5 months - sway in response to looming visual stimulus in supported standing

11-16 mo - sway in independent sitting

13-17 mo - new walkers sway excessively and apt to fall due to looming stimulus

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13
Q

Sensory Systems & how they work together w/ postural control (3)

A
  1. Visual - feedback (closed-loop) correction and feedforward (open-loop or anticipatory) control
    - problems w/ looming visual stimuli
  2. Vestibular - regulate head control & reference gravitational forces
  3. Somatosensory - body positioning & righting
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14
Q

Postural Milestones

  • Maintain head to 45deg; crawling
  • sit independently
  • creep
  • cruise
  • stand independently
  • walk independently
A

maintain head to 45deg - 2 mo

Crawling (on belly) - 2 mo

sit independently - 6-7 mo

creep (hands and knees) - 8-10 mo

cruise (pull to stand) - 9-10 mo

stand independently - 12-13 mo

walk independently - 14-18 mo

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15
Q

Locating a target - Reach & Grasp

  • at birth
  • 3 months
  • 4 months
  • 5 months
A

Newborns - limited smooth pursuit, track objects using saccadic eye movements (improves in 6 weeks)

3 months - can track objects well

4 months - can disengage from object after period of “obligatory looking”

5 months - uses head and eyes together to locate and track an object

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16
Q

Eye-Hand-Head Coordination

  • 2 months
  • 2-4 mo
  • 4 mo
A

2 months - head-arm movements are strongly coupled

2-4 mo - head and arm movements begin uncoupling, allowing for more flexibility

4 mo - infants gain postural stability, providing stable base and allowing for EMERGENCE OF REACHING

17
Q

Rudimentary Reaching & Grasping

  • newborn
  • 2 mo
  • 3 mo
A

Newborn - moves arm when visually fixated on an object; uses a REFLEXIVE grasp (open hand; extensor synergy)

2 mo - freq of reaching dec (closed fist)

3 mo - freq of reaching inc (hand open)

  • begin aiming w/ reaching
  • reaching movements are VISUALLY TRIGGERED
18
Q

Infant Reaching & Grasping

  • 4-5 mo
  • 6 mo
  • 8-9 mo
  • end of 1st year
A

4-5 mo - reaching occurs in “steps”, bimanual, elbow locked, VISUALLY GUIDED (not triggered), Palmar grasp emerges

6 mo - reaching becomes smoother, flex/ext of elbow, if view of hand is obstructed then grasp performance decreases, radial palmar grasp emerges

8-9 mo - coordinated bimanual reaching, transfers objects and has controlled release, pincer grasp emerges

end of 1st year - ballistic strategy emerges (allows for corrective movements), grasp initiated earlier in reach and timing similar to adults

19
Q

Childhood Reaching

  • 5 yr
  • 7 yr
  • 9-11 yr
A

reaching changes little from 9mo to 7 years

5 yr - ballistic reaching w/ lots of feedforward information

7 yr - closed-loop strategy, using visual feedback

9-11 yr - combine ballistic and visual strategies to improve efficiency and reduce amount of attention required

20
Q

Childhood Grasp

  • 2 yr
  • 4 yr
  • adults
A

2 yr - grip and load force are NEG correlated, tendency to over-shoot target (may use more force than needed)

4 yr - use anticipatory control, grip and load force are POS correlated (less overshooting)

adults - grip & load forces are programmed in parallel, prevent slips, gripping too hard

21
Q

Intrinsic Factors affecting Reaching (4)

A
  1. Age: birth - 1 (visual strategy); 1-9 yr (ballistic strategy); 11+ (combo)
  2. Experience (new synapses)
  3. Postural Control (closely related)
  4. Developmental delay (delayed motor control leads to weak MS system and poor ability to reach)
22
Q

Extrinsic factors affecting Reaching (3)

A
  1. Task demands/extrinsic factors (i.e. color of object, weight, size, etc)
  2. Vision
  3. Coordination
23
Q

Object Manipulation

- two major features

A
  1. Control of hand

2. Object manipulation & release

24
Q

Milestones of Fine motor function (object manipulation)

-2 months to 9.5 mo

A

2 mo - rotation of held objects
3 mo - translation of grasped objects
4 - vibration (shaking)
4.5 - bilateral hold & 2-handed hold
4.5-6 - hand to hand transfer
5 - 6.5 - coordinated action w/ single object (one hand holds, other bangs )
6 - 8.5 - coordinated action w/ 2 objects (bang them together)
7 - 8.5 - deformation of objects
7.5-9.5 - instrumental sequential actions

25
Q

Cognition & Object exploration

  • 6-7 months to 3 years
  • from finding to puzzle
  • separation anxiety
  • stacking blocks
  • pretend play
A

6-7 mo - find partially hidden objects
8 mo - object permanence, separation anxiety
12 mo - use objects correctly, imitate gestures
13-15 mo - stack 2 blocks, adapt reaching to weight of object
18 mo - stack 3 blocks, understand objects go together
2 yr - stack 6 blocks, sort by shape/color, begin pretend play
3 yr - completes puzzle w/ 3-4 pieces

26
Q

Rolling

- 1-2 mo, 4, 4-5, 6-8, 9

A

pre-req for supine-sit or supine-stand behavior

1-2 mo - roll sidelying to supine
4 mo - prone to supine
4-5 mo - supine to sidelying
6-8 mo - supine to prone
9 mo - segmental rotation (rather than log-rolling)
27
Q

Milestones of walking (4)

A

birth - 3 mo - stepping reflex
3-4 mo - stepping reflex disappearance
8-10 mo - stepping reflex reappearance, walk w/ assistance
9-15 mo - independent walking

7 years - gait fully matured

28
Q

Prerequisites to gait (5)

A
  1. adequate motor control & CNS maturation
  2. muscle activation patterns for pelvic stabilization
  3. adequate ROM and strength
  4. appropriate bone structure/composition
  5. intact sensation
29
Q

5 attributes of mature gait

A

If missing attribute in mature gait, look for loss in prerequisite

  1. stability in stance
  2. sufficient foot clearance
  3. appropriate pre-positioning of foot for initial contact (heel contact)
  4. Adequate step length
  5. energy conservation
30
Q

Characteristics of supported walking (getting ready for gait)
- birth to 9 mo

A

Hip abduction, ER and flexion
Bowed legs
everted heels, on toes
postural control and extensor muscles from top-down

31
Q

Characteristics of gait at onset of walking

9-15 mo

A 
Hip abducted, flexed and ER
Internal tibial torsion
tibiofemoral varus
everted heels
wide BOS
increased hip/knee flexion
full foot initial contact
short stride w/ increased cadence
relative foot drop during swing
COM @ lower TS level
uses coactivation for stability
32
Q

Characteristics of gait

18-24 mo

A

straight tibiofemoral angle
BOS decreased
hip abd no longer excessive
increased ant/post movement over planted foot - heel strike at 24 mo
COM descends
stability improves
decreased contraction of antagonistic muscles

33
Q

Characteristics of gait

3-7 years

A 
joint angles mature into adult patterns
tibiofemoral valgus
consistent heel strike
COM lowers
walking velocity normalized for height
34
Q

Characteristics of gait

6-7 years

A

gait patterns fully mature (see 5 attributes to mature gait)
femoral anteversion largely resolved
heel position neutral
tibiofemoral angle returned to neutral
COM at L3 (still slightly higher than adults)

35
Q

Stages of gait

- initial, elementary and mature

A

initial - short steps, increased hip/knee flexion, less foot contact, wide BOS

elementary - smoothing pattern, step length inc, heel-toe contact, initial swinging of arms, little inc in pelvic tilt, BOS gets smaller

mature - reflexive arm swing, narrow BOS, relaxed and elongated gait, good heel-toe contact

36
Q

Determinants of mature gait (diff from attributes) (5)

A
  1. duration of SLS
  2. walking velocity
  3. cadence
  4. step length
  5. ratio of pelvic span: ankle spread
37
Q

Skeletal Adaptations w/ Gait

  • development of bone
  • femoral anteversion
A

bone will INC in SIZE before it increases in STRENGTH

  • WB activities are important
  • may be at risk for osteopenia if decreased levels of movement

Femoral anteversion - 30deg at birth

  • DEC w/ normal development
  • excessive anteversion results in an in-toed posture w/ increased in “w sitting”
38
Q

Other motor milestones (other than the key 6)

A

8-14 mo - creep up/down stairs
15-18 mo - walk up/down stairs w/ hand held
20 mo - run stiffly
2.5 years - walk up/down stairs w/o support (marking time)
3 years - run well, alternate feet up stairs, catch ball w/ arms and body
4 years - gallop
5-6 years - skip

Pediatrics (6 decks)

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