Exam 2 Flashcards
distributed vs massed has to do with
intensity
Blocked vs random has to do with
sequence
explain constant vs variable
has to do with variability. consistant performance of the same task, vs varying char of the task
guidance vs discovery
how much you are involved, are you letting them discover most of the solutions themselves or are you primarily guiding them
KR vs KP
knowledge of results vs knowledge of performance (KR better)
Serial, continuous and discrete
serial - multiple discrete tasks in a row
continuous-no beginning or end
discrete- has beginning and end
4 main factors contributing to postural control
MSK sx
neuro sx - sensation
Neuromusular sx - control and coordination
enviroment
postural control develops cephalo caudel, meaning
head to toe
reflexes that effect the tone of the entire body
attitudinal/postural
3 main types of reflexes
attitudinal/postural
righting
balance/protective
in the hierarchial theory of development, what reflex type is the foundation
attitudinal/postural (lack of these often indicate dev delay or pathologies)
List the 3 attitudinal/postural reflexes
asymmetrical tonic neck reflex
symmetrical tonic neck reflex
tonic labyrinthine
explain asymmetrical tonic neck reflex
fencer pose
asymmetrical tonic age range
birth - 6 mos
explain symmetrical tonic neck reflex
whatever neck does, UE follow, and LE do opp
explain tonic labyrinthine reflex
when placed prone, babies will flex their bodies inward
when placed supine, they will extend outward
age range of tonic labyrinthine reflex
up to 6 mos
5 righting rxns
labyrinthine righting optical righting body on head righting body on body righting neck on body righting
what is labyrinthine righting
you do something to restrict/prevent their vision, and as you tilt the suspended body, they maintain upright head (horizontal gaze)
what is optical righting
same as labyrinthine, but without loss of vision
how long do we have labyrinthine and optical righting
over the lifespan
what is body on head righting
when the body is placed prone, the head will want to be upright
how long do we have body on head righting
up to 5 yrs
what is body on body righting
if you rotate a segment of the body (ex UE) the opposing segment (LE) will follow to align
what is neck on body righting
as you rotate their head, the body will follow suit
___________ are innate reactions that align the body for proper alignment
righting reactions
List the balance/protective reactions
equilibrium (tilting)
Postural fixation
List the time frames of when we start to see balance/protective reactions for prone, supine, sitting, quadruped, standing
Months prone 6 supine 7-8 sitting 7-8 quad 9-2 wallking 12-21
protective reactions occur when
COG is outside of the normal limits or when there is a LOS
which balance/prot rxn is when the baby curves the trunk and uses extremities to try and correct/straighten the tilting
equilibrium
which balance/protection rxn occurs as baby is reaching, displacing COG and the baby curves the trunk towards the external force
postural fixation
as the dev of reflexes become integrated they reinforce what
muscle tone
typical age of starting to crawl
8-10 mos
typical age of sitting upright
6-7 mos
typical age of leaning against something as they stand
9-10 mos
typical age of independent stance
12 mos
what is a key component to dx dev delay in babies, what are we looking at very early
head control
normal posture control depends on
COM
BOS
reflex hierarchial theory states that reflexes are all____ to balance
reactive
according to hierarchial theory, list the tiers or levels of what babies achieve in regards to balance/posture
1st - attitudinal reflexes
2nd -righting reflexes
3rd - balance/protective reflexes
then postural control
what is systems theory
states that anticipatory responses act when we are aware of the need to change our position/posture. anticipatory responses develop parallel to reactive
4 stages of motor control
initial mobility stability controlled mobility skill (I S C S)
explain initial mobility stage
AROM is required for posture (ex: baby prone on elbows)
explain stability stage
baby can hold the posture (maintains it)
explain controlled mobility stage
baby can control or shift wt
explain skill stage
baby can reach out in front
prominent sensory system used at birth-few days (newborn)
visual
prominent sensory sx used around 1 yr
somatosensory (proprio)
prominent sensory sx used at 7 yrs
vestibular
1st postural reflex developed
postural support reflex (you hold a baby upright over the floor and have their feet touch, they will try to support their wt)
explain landau reflex
prone baby, they will kind of stiffen up and extend
components to include when looking at the INDIVIDUAL in a posture/balance assessment
body structure
body function
cognition
babies begin to extend neck fully at what age
2 mos
motor control relates to ___ and ____ function
brain and spinal cord
motor performance is influenced by what body systems
all
what were the 4 components of motor learning
retention
generalizability
quality of movement
resistance to contextual change
postural control is the ability to maintain equilibrium both ___ and ___
statically and dynamically
what is posture orientation
maintaining appropriate relationship btwn body segments
how to measure static control
how controlled are they for a certain amt of TIME
what is meant by limits of stability
your movement is contigent on your BOS, if your BOS is small and narrow, your movement will be too
how to improve limits of stability
make your BOS larger
4 strategies of postural control
sensory
motor (the mvmt)
sensory motor (the coordination involved)
attentional (degree of attention required)
3 factors contributing to quiet stance
muscle stiffness
tone
antigravity contractions
3 main antigravity synergy sxs
abs and erectors
hip flexors and gluts
plantar/dorsiflexors
3 ways to objectively measure posture control
EM (electromyography)
kinematic analysis
kinetic analysis
which way to measure postural control involves videos with markers on the pt to check symmetry, includes forces velocity
kinematic
which way to measure postural control involves use of internal and external forces with plates and gages
kinetic
in general, forward sway, causing ankle strategy inacts what muscles
ALL post leg (plantar flexors and hams), and paraspinals
Hip strategy: backward sway inacts what muscles
abs, quads
forward pert (hip strategy) enacts what muscles
hams, paraspinals
high velocity pert. use what strategy
hip
velocity of pert. that causes loss of control
stepping
lateral pelvic mvmt or mediolateral, when you shift your wt, the leg you are loading the wt on is ADD or ABD
load bearing leg is ADD
other leg is ABD
antigravity support muscles are provided by ____(mono articulating or biarticulating) muscles
mono
horizontal stability muscles in hip
quads (biarticulate)
when training a pt with a new LE prosthetic, its important to teach them to
bear wt on new prosthetic side to avoid hip hike/imbalance
sensory components of postural control (main contributors)
vision
vestibular
somatosensory
touch
Postural control depends on 5 important aspects of the INDIVIDUAL
COM BOS LOS motor strategies sensory strategies
As we age we lose ___muscle fibers
fast twitch
postural responses in older adults are ____ and___
delayed and weaker
what is foam and dome
clinical test for sensory integration/balance
goal writing strategy (saying)
FSMART
functional, specific, measurable, attainable, relevant, time
How does the infant’s BOS and COM change through the developmental stages?
goes from flat and big to smaller and narrow (belly on floor to feet on floor)
COM for a child goes from
low to high
independent stance for babies comes at what age
12 mos
what muscles are activated for quiet stance
Erector Spinae, Iliopsoas, Glute med, Abs, TFL, Gastroc, Soleus, Tibialis anterior (A E I G G T T S)
What factors (intrinsic and extrinsic) affect postural control?
stiffness, tone, antigravity muscles contracting body systems, proprioception all are intrinsic examples
floor, environment, shoeware are examples of extrinsic
at hip, mediolaterally, what is going on with the muscles in regards to strategies for muscle control
hip flexors unload
hip extensors load
list muscles in quiet stance
AEI GG ST (abs, erectors, iliopsoas, gastroc, gluts, soleus tibialis ant
muscles inacted with backward ankle strategy (pushed back)
ant tib, quads abs
overall, list some deformities that can occur from most of the reflexes if they continued
spine abnormalities, contracted vs lengthened imbalances, weak muscles
postural asymmetry could lead to
scoliosis
if the optical righting isn’t working, what could this lead to
torticolis or kyphosis or altered perception dt altered vision
how could protective extension imbalance (child extending arm when falling to the ground) somehow lead to an issue
if they favor one side the other is inhibited
optical righting happens at what age
2 mos
prone to elbows what age
2 mos
log rolling what age
4 mos
age of walking
14 mos
How does sensory input for postural control changes across the lifespan
mostly decreases, vision, proprioception, tactile sensation, all decline
list some extrinsic reasons that elderly pts fall
lighting, stairs, pets, assistive devices, weather.
list some intrinsic reasons why elderly pts fall
type II fibers decrease, vision, proprioception, age, gender, meds, any psychosocial or physical
What types of therapeutic interventions are appropriate for balance problems, based upon risk factors leading to increased fall risk
balance training: changing surfaces, obstacles, eyes open eyes closed MSK - strengthen muscles involved in strategies, and endurance NM - pertebations Sensory -proprioceptive drills Postural - increase anticipatory ability Cognitive - mental practice Education on risk factors Referral if needed (glasses, devices)
- How would a physical therapist progress a treatment plan based upon cephalo-caudal development and the development of postural control?
Gradually changing the COG by changing the base of support. For example, from a large BOS, prone head raising, to a smaller BOS, supported sitting, to changing the COG even more, sitting with movement, to standing supported, standing unsupported, standing and reaching, etc.
which reflexes contribute to the dev of postural control
ALL
Attitudinal or Postural Reflexes (reflexes that influence the tone of the entire body)
Righting Reactions (reactions that right the body for proper alignment)
Balance and Protective reactions – Reactions that contribute to the maintenance of balance
what are some reflexes that contribute to head control early on
the righting ones that try to keep vision horizontal (optical righting, labyrinthine)
What reflex contributes to prone on elbows
body on head
body on head righting reflex starts/ends when
starts birth ends 5 yrs
labyrinthine and optical righting lasts
lifetime
neck on on body and body onn body start/end when
6 mos -5 yrs
the ability of a baby to control its head increases with
sensory input
in regards to fall assessment, what are 3 first things to ask
have you fallen, how manytimes, was there a specific cause
what are specific goals to focus on for fall intervention/prevention
speed (TUG), strength of muscles involved in strategies, education, proprioception
with aging, postural sway (inc or dec)
increases, their perception or feelings are decreasing
most falls occur when
walking lifting or carrying, this stuff should be incorprated late in balance training
dont forget to include the pts ___ in your plans/goals
env (bath mat, rug, dog, grab bars)
what 2 righting reflexes should be present at birth
lab, optical
postural stability
COM over BOS = equilibrium
plumb line
mastoid, ant shoulder, behind hip, ant knee, ant ankle
