Exam 3 (Peds and Geriatrics) Flashcards
4 Motor Control Factors
1) Neural: structures, pathways, processes participating in movement
2) Physiological: various body systems contributing to movement (ex: thermoregulate, integumentary, etc)
3) Biomechanical: structures/properties of muscles, joints, and soft tissues and physical laws governing them (ex: short vs. long lever arm, COM to BOS when trying to stand, etc.)
4) Behavioral: cognitive, emotional, motivational, perception (of task, environment, and condition), movement outcome in terms of satisfying a goal
Stages of Movement in the Motor Control Framework
1) Initial Conditions: state of individual
- posture
- environment/ability to interact with environment
2) Preparation: organized in CNS (cant see it)
- stimulus identification
- response selection/programming (normal synergy, weight shifting, etc.)
3) Initiation: moment movement BEGINS
- timing (hesitation, delay)
- direction
-smoothness
4) Execution
- amplitude
- direction
-speed
-smoothness
5) Termination: moment movement STOPS
- timing
- stability (keep COM w BOS)
- accuracy
6) Outcome: success? possible improvements to be made?
Motor Control Framework
1) Movement Examination
- where movement does problem occur
2) Movement Analysis
- hypothesize determinants for problem
3) Plan of Care to Address Movement Dysfunction
4) Outcomes
Movement Analysis and PT
· Initial/ongoing assessment
· Helps prioritize and focus intervention
· Match patients progress by developing strategies rather than technique for treatment
· Justifies why patient needs your services
· What is mvmnt problem?/ Why is it occurring?
· Qualitative/Quantitative identification
Medical Diagnosis vs PT Diagnosis (Movement Dysfunction)
· Medical Diagnosis: Pathology that causes impairments
· PT Diagnosis: Impairments that cause Functional Limitations
Levels of PT Diagnosis
· Bodily Structure and Function/Impairment Level (MSK)
· Multi-system-impairment (NMR)
· Activity/Functional Limitation level and skill (motor control)
· Participation (societal roles)
Skill
Ability to achieve meaningful goals with consistency, flexibility, and efficiency
Pathoanatomical Limitation
Does not always explain the full story
Child Find Program/Infants and Toddlers/Early Intervention Program
· Surveillance and prevention program
· For children at risk of developmental delays (up to 3 years old)
· Anyone can call to recommended
· Insurance not required
· Services offered: in home OR center based (at a facility)
What could interference during embryonic stage cause?
· Hamper development of organs, systems, and structures which will persist throughout life
·Spina Bifida due to neural tube (which becomes brain and sc) not fully closing
Critical Periods of Pre-natal development
1) Germinal Stage (conception-2 weeks)
- cells begin to differentiate
2) Embryonic Stage/ CRITICAL STAGE (3-8 wks)
- rapid cell division and differentiation
- vital organs FORMED (ex: neural tube closes)
3) Fetal Stage (9-40wks)
- movement BEGINS
- growth of major organs and body parts
3 Factors causing atypical development
1) Teratogens: an agent that produces malformations (ex: infections, medications/substances)
2) Genetics: genetic alterations passed vis genes (ex: Down Syndrome/Trisomy 21)
3) Internal Environment: “packaging problem”/ confined position in uterus resulting in deformities (ex: club foot, congenital hip dislocation, contractures, metatarsus adductus)
Atypical Pre-natal Development Motor Ability Outcomes
· Lower scores on tests for motor ability
· Uncoordinated movements
· Motor learning issues
APGAR Test (at birth)
· Appearance: skin
· Pulse: HR
· Grimace: reflex response
· Activity: muscle tone
· Respiration: breathing
· Assesses general wellbeing, performed at 1/5/10 minutes
· 10 pts total= perfect, 0-2 pts total= problematic
Age Abbreviations and equations
· Chronological Age (CA): birth to present
· Gestational Age (GA): conception to birth
· Adjusted Age (AA): birth to present - Time missed
*for premature babies, calculated until baby is 2 YEARS OLD, expect performance based on this age
2 Equations:
· Full Term (FT) - GA = time missed
· CA- time missed = AA
Birth Time Frame
· Premature (< 36 weeks)
· On time (40 weeks)
· Early but not premature (35-39 weeks)
Role of Primary (Primitive) and Postural (Attitudinal) Reflexes and difference between them
· Survival
· Interact with environment
· Foundation for future movements
· Difference: Postural DONT go away
4 Types of Reflexes/Reactions in Pre-Adapted Period (2-4 weeks to 1 year)
1) Survival/primary
· Rooting, sucking (-7 to 2/3 mo)
2) Attitudinal/postural reflexes
· ATNR (birth to 4/6 mo)
· STNR (UNUSUAL attitudinal)
3) Voluntary Movement Preparation
· Positive Support (-8 to 2/3 mo)
· Step (-8 to 2/3 mo)
· LE Placing (-8 to 2/3 mo)
4) Postural reactions (righting, equilibrium, awareness of where we are in space, KEEPS FOREVER)
· Head Righting (optical) (starts at 4mo)
· Head Righting Labyrinth (starts at 4mo)
· Neck on body (starts at 5 mo)
· Body Righting (starts at 5mo)
Neuromaturational Development Theory
Level 1 (Spinal Cord): Primary reflexes
Level 2( Brainstem): Postural reflexes
Level 3(Midbrain): Righting reactions
Level 4 (Cortex): Willful Behavior (equilibrium)
Reflexive Period (Birth through 2-4 weeks) vs. Pre-adapted Period (2-4 weeks to 1 yr)
1) Reflexive Period:
· Posture: flexor synergy
· Movement:primary reflexes
2) Pre-adapted Period:
· voluntary movement
· progression of positions,postures, transitions of functional movement (ex: prone, supine, sitting, standing)
* Helpful in diagnosis of delay
PT assessment of infant development
· Reflexes
· APGAR
· Interaction ability
Major Motor Milestones/ Quarterly goals
(Month:Milestone)
· 1-2: Lift head in prone
· 3-4: Head control
· 5-6: Supine to prone
· 6: Prone to supine
· 5-6: Sitting momentarily
· 6-7: Controlled sitting
· 8-9: Crawling/creeping
· 10: Stands alone
· 11+: Walks alone
(Quarterly Goals)
·1st Q (0-3 months): lifting and aligning head
· 2nd Q (4-6 months): pushing up and sitting up
· 3rd Q (7-9 months): constant motion on various surfaces, scooting, crawling, creeping, cruising
· 4th Q (10-12 months): walking
Alberta Infant Motor Scale (AIMS) assessment tool
· Detects gross motor delay WITHIN POSTURE (supine, prone, sitting, standing)
· Develops simultaneously not sequentially (meaning within each posture theyre developing different things, dont fully master one before testing the other, ex: dont need to get through all of supine or prone before starting supported sitting and standing)
· 0-18 months
· Validity and reliability
· Sensitive (doesnt miss babies who might be at risk) NOT specific (does NOT diagnose)
Infant Gross Motor Development and Environment
· Follows a sequence
· Development of extensors, flexors, rotator muscles for postural control
· Equilibrium control AFTER being in a position (get to a position and then experiment with it)
· Stability before mobility, proximal before distal
Infant Fine Motor Milestones
· Reach and grasp (VOLUNTARY, pre reqs for reaching)
· Grip progresses from Ulnar side to radial side during 4 months - 1year
· Sequence: Ulnar palmar/primitive squeeze (4 months) to palmer (5 months) to radial palmer (6/7 months) to radial digital (8/9 months) to pincer/precision grip (9/10 months for inferior/pads of fingers, 11/12 for superior/tips of fingers)
Cardiopulmonary System
· Ducts/shunts CLOSE at birth, pulmonary still NOT efficient
· Increased HR (120-180 bpm) and RR (30-40 breaths/min)
Skeletal System
· Large Heads
· High center of gravity
· Growth is cephalo-caudal and proximo-distal
Muscular System
· Hypertrophy after birth (Hyperplasia before birth)
Nervous System
· Excess motor neurons at birth is normal
· Natural pruning occurs
· Myelination occurs over time (ex: cerebellum by 1.5 years)
Sensory Systems: Vestibular, Auditory, Visual
1) Vestibular
· First system to develop (6 months after conception)
· Use begins BEFORE birth
2) Auditory
· Acuity is low/poor
· Perception increases around 4 months for Primary caregiver’s voice
3) Visual
· Not fully developed, myelination and synaptic potential continues
· Contrast> color initially
· Good visual acuity by 6 months
· Most change occurs during 1st year
Cognition vs Perception
· Cognition: intention, attention, memory, information processing
· Perception: understanding the meaning of information
Receptive vs Expressive (Language Development)
· Receptive: localize familiar sound (4 months)
· Expressive: babbling sounds (5 months), reinforces sounds (11 months)
ATNR (Asymmetric Tonic Neck Reflex)/ archer
Motor Development Pyramid
1) Prenatal: -9 mo to birth
2) Reflexive: Birth to 2-4 wks
3) Pre-adapted: 2-4 wks to 1yr
4) Fundamental Skills: 1 to 7yrs
5) Context-specific: 7 to 11yrs
6) Skillful: 11+yrs
Infant Reflexes begin/end
· Rooting: 7 mo gestation to 2-3 month
· Sucking: ^
· ATNR: birth to 4-6 mo
· Positive support: 8 mo gestation to 2-3 mo
· Step: ^
· LE placing: ^
Postural Reactions (start time)
· Heading righting (optical): 4 mo
· Head righting (labyrinth): 4 mo
· Neck (on body): 5 mo
· Body on body: 5 mo
Equilibrium Reactions (start time)
· Sit: protective extension (FWD): 6 mo
· Sit: protective extension (SIDEWAYS): 8 mo
· Sit: protective extension (BKWD): 10 mo
· Sit Equilibrium: 8 mo
· Quadraped Equilibrium: 10 mo
Importance of Labyrinthe head righting
· Baby has eyes covered (“vision obliterated”)
· Uses vestibular system to perform head righting, determines if vestibular system is in tact