Evaluating Gross Motor and Mobility in pediatrics Flashcards
Early movements provides
foundation for later growth, learning and sensory
motor control and movement is essential to out
participation in occupations
kids needs what to master motor skills
repetition
Dynamic Systems Theory
Takes into account the learning (the brain) but also the influence of the body and environmental variables.
Motor behavior- Emerges through dynamic cooperation of subsystems required in a task
“Dynamically stable behavior pattern”
Internal variables
of dynamic system theory
motivation
temperament
fatigue level
external variables of dynamic sustem theory
who is there, what type of feedback are you getting
environmental contrainsts of dynamic system theory
how does the environment impact your movement
task constraints
of dynamic system theory
everything involves in the movement itself. the goal, the equipment, certain grasp needed.
Motor Control-
How one directs and regulates the movement
Motor Learning-
How child learn movement
Helping the child achieve goal-directed functional actions
Occupational based approach as it is directed toward the search for a motor solution that emerges from an interaction of the child with the task and the environment.
Feedback – knowledge of results and knowledge of
performance
Practice
Demonstration
Mental imagery
Key techniques used in motor learning
Verbal instruction
Physical and manual guidance
movement deficits
presents as poor coordination, timing, sequencing, bimanual control, balance, sensory processing and motor planning
Common diagnoses that cause movement deficits
Cerebral Palsy (CP)
Developmental Coordination Disorder (DCD)
Autism Spectrum Disorder
Down syndrome
Sensory Integration Disorder
Acquired Brain Injury
Etc.
We treat what is
in front of us.
Ages and Stages Questionnaire 3
1 month - 51/2
available in multi languages
takes parent 10-15 min, 2-3 to score
monitoring zone to indentify children at risk for delay
communication, gross motor, fine motor, problem soling and personal -social
Not standardized but a screening tool.
How do we evaluate movement in young children?
I. Observations
II. Facilitation of movement through movement progression
III. Informal Assessments
Movement Observation Checklist (Qualitative Assessment of Postural & Movement Strategies)
Bayley Infant Neurodevelopmental Screener (BINS)
IV. Formal Assessment
Bayley Scales of Infant Development (Bayley III/IV)
Peabody Developmental Motor Scales (PDMS-2)
Battelle Developmental Inventory (BDI-2)
In our evaluation template we are putting all of our observations in the
first part.
Movement Evaluation: I. Movement Observations
Observe movement in all positions
Comment on motor planning/coordination issues observed
Assess tone and any ROM limitations.
How do you observe ROM in children
play.
symmetry
Both sides of the body involved in equal proportions
weight bearing
allows maintenance of position in space supported on a specific part of the extremities.
Child bears weight in position before they can
move in it!
Preferred position
Position that the child is found in most of the time and / or tolerates the longest
Undifferentiated
no difference in body segments around moving joints
Differentiated
increased stability allows for independent movement at one joint while maintaining stability at other
Evaluation: I. Movement Observations
Observe movement in all positions
Movement Evaluation: 2. Motor Planning/Coordination
Observe the quality of movement:
Smooth/continuous vs Rigid/broken up
Pacing of movement
Awareness of surroundings/ Interaction with environment
In typical movement-the strength and intensity of the muscle contraction is monitored by the
cerebellum so that the movement is smooth «
Movement Evaluation: 3. Assess Tone/ROM
Normal muscle tone present in the muscle ensures that movement is coordinated and isolated/ controlled
Abnormal tone can limit ROM
Abnormal tone interferes with normal movement!
Movement Evaluation: 3. Assess Tone/ROM
infants
assess UE/LE in supine or supported sit
AROM: Observe how they reach for objects/toys
PROM: Playful manner- sing songs, eye contact
TONE: Quick stretch, Scarf test for shoulder
Older children assess tone/ROM-
Observe functional AROM as they play
PROM/TONE assessment similar to adults- more “playful” (song/game)
Normal tone is
slight tension in the muscle that indicates the readiness of the muscle to contract
hypotonicity
heavy, limp, floppy
Instability and dislocations at the joint
Shortening or contracture = restricing movement
Common in childhood diagnosis
what type of tone does down syndrome tend towards?
low tone
Hypertonicity
Rigid, tight, stuck in extension or flexion and hard to move
muscles stay in a shortened or contracted position leading of contractures
common in childhood diagnosis of cerebral palsy and TBI
what type of childhood diagnosis most likely leads to high tone
TBI and CP
types of cerebral palsy
Spastic- hypertonia present. Excessive stiffness in the muscles.
Dyskinetic- Movement is classified as athetoid, choreoathetoid and dystonic. Exhibits excessive and abnormal movement.
Ataxic- Characterized by poor balance and coordination. May show shifts in muscle tone.
Mixed- combination of low and high tone
Spastic CP-
hypertonia present. Excessive stiffness in the muscles.
Dyskinetic CP-
Movement is classified as athetoid, choreoathetoid and dystonic. Exhibits excessive and abnormal movement.
Ataxic CP-
Characterized by poor balance and coordination. May show shifts in muscle tone.
Mixed CP
combination of low and high tone
PRIMITIVE:
Undifferentiated movement
Postural support provided by external stability
Change position of body segments NOT body in space
Tonic labrinthyne reflex dominates (flexor tone in prone, extensor in supine 2’to gravity)
Waht stage are they in if they can’t move their body in space?
primitive
what primitive reflex dominates in primitive state
tonic labrinthine reflex
Transitional movements
Total Movement
Weight Shift & Movement
Righting Reactions
Protective Reactions
mature phase
Get in and out of position freely
Movement within posture
Internal stability
Midline Stability Reactions
Equilibrium reactions
When a baby doesn’t need external support in a posture what phase are they in?
mature
observations are what kind of assessment
informal
What are the two types of formal assessments used
norm-referenced and criterion referenced
What is a norm-referenced assessment
standardized
found a normative sample
norms
when giving this test we are comparing a child to the norms
Purpose is to determine how a child performs in relation to average performance.
What is a criterion referenced assessment
may or may not have standardized administration and scoring
child’s performance is compared to the completion of the skill
goal is to determine what skills the child can accomplish
purpose is to measure performance on a specific task and get a sense of where to start intervention
Bayley Scales of infant development (Bayley IV)
what is the age?
1-42 months
Is the Bayley norm referenced?
Yes
What 5 developmental domains does the bayley look at
adaptive behavior, cognitive, language, motor, social-emotional
How many subsets might we utilize in the bayley?
2 or more.
What age groups is the Batelle developmental inbentory
Birth - 7yr 11 months
Why might you choose to buy the Batelle over the Bayley?
the age range is wider and you can use it longer
What developmental domains does the Batelle cover?
adaptive, personal-social, communication, motor, cognition
Is the Batelle norm referenced?
yes
How is the scoring done on the battelle?
developmental quotient and subdomain scaled scores
What age group does the Developmental Assessment of Young Children (DAYC) test?
Birth - 5 years old
What developmental domains does the DayC cover?
adaptive, personal-social, communication, motor, cognitive
Is DayC norm referenced?
Yes.
How is the scoring done in the DayC?
Standard Scores, Percentiles and Age Equivalents
What is one of the nice things about DayC
it can be through interviews and through telehealth
What the kid qualifies for services what do we need to do
write outcomes
What do the outcomes need to be?
Necessary and functional for the child and family’s life.
Reflects real-life (routine based)
Discipline-free
Jargon-free, clear and simple
Emphasizes the positive
Uses active words
Sample outcomes for 7 month old
Amy will play with toys while weight bearing on arms in a variety of positions.
Amy will eat finger foods while seated in her highchair during meal times.
Amy’s parents will utilize handling skills to encourage Amy to participate in dressing.
Write outcomes for Amy
Write outcomes for Amy
Write outcomes for Amy
