Intro + Typical Development (0-12 Months) Flashcards
The “Pediatric” pt population refers to which age group?
0-18 years of age
Stages of Chronological Development
Infancy: Birth - 1 year (Neonatal: Birth - 2 weeks of age +
Infant: 3 weeks - 12 months of age)
Toddlerhood: 13 months - 2 years (2 years, 11 months)
Early Childhood: (Preschool - 3 to 5 years + Elementary School - 5 to 10 years, 11 months)
Adolescence: 11 - 18 years
Young Adulthood: 18 - 22 years
Adulthood: 22 - 40 years
Middle Age: 40 - 65 years
Late Adulthood (Older Adult): 65+
Advanced Maternal Age (AMA)
Pregnancy where mother is 35+
What did Erik Erikson believe?
A specific psych struggle occurs throughout the 8 stages of a person’s life
These struggles contribute to your personality throughout your development
Erik Erikson’s Stages
What is a child’s main occupation?
Play!
Normal development skills typically acquired through play
What has the greatest influence on a child’s functioning/development as an adult?
Family!
What impacts the child also impacts every other member of the family
ICF-CY
ICF Child and Youth Version
The ICF-CY attempts to ___.
Capture growth/development of a disability
Identify variety of abilities/levels of functioning seen in children with the same diagnosis
ICF-CY Model (vs. Traditional Classification Systems)
Play codes to reflect child’s occupation of play
Continuity of documentation (transition from child to adult services)
Focuses on life, NOT mortality (QOL > inabilities)
ICF Terminology
(Function, Activities/Participation, Impairments)
Function: Relates to body organ/system, NOT functional activities
Activities/Participation: Functional activities
Impairments: Of the body, NOT the activity
The ICF-CY recognizes ___ and ___ as parallel processes.
development, disability
EBP “Stool” (Management of Children w/ Disabilities)
Best research evidence
Clinical expertise
Patient and their family/environment (important!!)
4 Elements of Good EBP (Law, MacDermid)
Awareness (PT aware of evidence that is available)
Consultation (child / family consulted as part of decision-making process)
Judgement (professional judgement in analyzing / using the info as it applies to a particular child and environment)
Creativity
Elements of Child Management (Leading to Optimal Outcomes)
Examination
Evaluation
Diagnosis
Prognosis
Intervention
Outcomes
Examination
Gathering data
3 Components: History / Systems Review / Tests & Measures
The type, frequency, and duration of the interventions are based on which factors? What is this list referred to as?
Age
A&P changes related to growth development
Chronicity/severity
Comorbidities
Degree of limitations
Level of cog ability / cooperation
Family (desires / degree of participation)
Caregiver ability / expertise
Resources
Concurrent services
Community support / psychosocial + socioeconomic factors
Above refers to Clinical Picture of Pt
3 Dimensions of Outcomes (Guralnick)
Child / family characteristics
Program / intervention features
Goals and objectives
3 Periods of Gestation
1st Trimester: Weeks 1 -12 (all major body systems established)
2nd Trimester: Weeks 13-26 (body proportions grow to newborn proportions)
3rd Trimester: Weeks 27-40 (body weight x3 and length x2, body fat accumulates to aid in temp. regulation)
At what point during gestation do Lungs develop?
36 weeks
Embryo vs. Fetus
Embryo: 1st 8 weeks
Fetus: 8 weeks until birth (full gestation is 40 weeks)
What determines the effect of environmental factors on fetal development?
Timing of exposure
Degree to which fetus is exposed
STORCH (Common Detrimental Environmental Influences)
Syphilis (bacterial infection spread through sexual contact)
Toxoplasmosis (parasitic infection, explanation as to why pregnant people should avoid changing cat litter)
Other Infections (HIV, Coxsackie Virus (lives in human digestive tract), Varicella-Zoster Virus (type of Herpes virus - chickenpox, shingles))
Rubella (viral infection, distinctive red rash, aka Measles)
CMV (Cytomegalovirus, related to Chickenpox + Herpes Simplex)
Herpes Simplex Virus (viral infection, painful blisters / ulcers)
“Typical Development” is dependent on ___.
NS maturation
Genetics
Environment
Development occurs in a ___ direction.
cephalo-caudal
proximal to distal
gross motor to fine motor
Newborns NEED to be able to ___.
breathe
suck and swallow
Apgar Score
Test performed at 1 minute / 5 minutes / 10 minutes (if needed) after birth
5 sections (scored 0 to 2) / total score of 1 to 10
Higher score = the better the baby is doing after birth
Around how long has fetal development been occurring once a baby is born?
38 - 42 weeks (40 weeks full term)
Premature vs. Extreme Premature
Premature: 37 weeks or less
Extreme Premature: 28 weeks or less
Newborn Appearance
Head proportionally larger with short LEs
Kyphotic, horizontal ribs
Dominated by physiological flexion and lack of anti-gravity muscle control
Newborn ROM Differences
Excessive DF
30 degree flexion contracture at hips and knees
Newborn Prone
UE flexion / held to body / hands fisted
LE flexion / highly positioned pelvis
Head turned to one side
Newborn Supine
UE flexion
LE flexion, abd, ER
Head turned to one side (no anti-gravity neck flexion so unable to hold in midline)
Newborn Pull to Sit
Head lag
Flexion throughout spine (c-curve)
Flexed at hips
Newborn Sitting
Head forward: no control / head bobbing
C-curve with flexion throughout spine (no anti-gravity extension)
Secondary spinal curves not yet developed
Newborn Vision
Easiest to fixate on a moving object laterally and vertically
Prefer strong contrasts
Best at 8 - 9 inches away
Primitive Reflex Definition
Involuntary motions that aid in the development of certain skills in babies / help babies survive and thrive
Replaced with voluntary motion as the baby’s brain matures
What can happen if the involuntary movements associated with primitive reflexes do NOT become voluntary as the child matures?
Child will struggle with both motor (running / cycling / posture) and cognitive (eye-hand coordination / eye tracking / difficulty focusing) skills
Flexor Withdrawal Reflex
Appears ~28 weeks gestation
Integrates 1 - 2 months
Stimulus - noxious stimulus to sole of foot
Response - flexion withdrawal of leg
Crossed Extension Reflex
Referring leg opposite to side engaged in Flexor Withdrawal reflex
Appears ~28 weeks gestation
Integrates 1 -2 months (inconsistent)
Stimulus - noxious stimulus to sole of foot
Response - flexion of stimulated leg and extension of opposite leg with adduction
Positive Support / Primary Standing Reflex
Hold baby under their arms / support their head / touch their feet to a flat surface
Will extend legs for 20 - 30 seconds before flexing legs and collapsing into sitting position (bearing weight for 20 - 30 seconds before collapsing)
Appears ~ 35 weeks gestation
Integrates 1 - 2 months
Support & Stepping / Automatic Walking
Steps reciprocally when inclined forward and pressure is applied to plantar aspect of foot
Appears ~ 37 weeks gestation
Integrates 3 - 4 months
Re-appears at 10-15 months in preparation for walking
Rooting Reflex
Appears 28 weeks gestation
Integrates by 3 months
Stimulus - baby in supine, stroke cheek
Response - turns head and lips towards stimulus
Sucking Reflex
Appears ~28 weeks gestation
Integrated by 3 months
Supine , bottle / knuckler, baby sucks symmetrically and strong
Suck-Swallow Reflex
Rhythmic excursion of jaw
Appears 28 - 34 weeks gestation
Integrates at 5 months
Moro Reflex
Sudden change in head position (extension) in relation to trunk results in crying + two movements back to back: flexion, abduction of shoulders and elbow extension / extension, adduction of shoulders and flexion of elbow
Appears ~28 weeks gestation
Integrated by 3-5 months
Asymmetric Tonic Neck Reflex (ATNR)
(In supine) head rotation elicits arm and leg extension (chin side) / arm and leg flexion (skull side)
Appears ~20 weeks gestation
Integrates at 4-5 months
Palmar Grasp
Appears ~28 weeks gestation (can be elicited at 25 weeks postconceptional age)
Integrates 4-7 months
(In supine) PT strokes infant’s palm with index finger
Two Phases: Finger flexion to enclose examiner’s finger (Finger Closure) / pressure to palm produces traction on finger’s tendons (Clinging)
What could a weak Palmar Grasp reflex possibly indicate?
Peripheral nerve involvement - injury to root / plexus / SC
Persistence of the Palmar Grasp Reflex beyond ___ months is usually present in children with ___.
7 , spastic cerebral palsy
A reappearance of the Palmar Grasp Reflex in adulthood indicates what?
Cortical lesion affecting medial or lateral frontal cortex (e.g., ischemic or hemorrhagic stroke)
Tonic Labyrinthine Reflex (TLR)
Present at birth / integrated by 6 months (best seen at 3 months)
Prone - infant with greater flexion tone / supine - infant with greater extension tone
Neck extended - increased extensor tone / extension of all limbs
Neck flexed - increased flexor tone / flexion of all limbs
Symmetrical Tonic Neck Reflex (STNR)
Appears 4-6 months / integrates 8-12 months
W/ head flexion - arms flex and hips extend
W/ head extension - arms extend and hips flex
Helps with learning how to fall / crawling
TLR less involved at this point
Plantar Grasp Reflex
Pressure to sole of foot (just distal to met head) / supported standing
Responds by flexing toes
Appears ~28 weeks gestation
Integrates by 9 months
If a TLR is not integrated after 6 months, what symptoms could be observed?
Poor posture
Weak muscle tone (skinny arms / legs)
Poor sense of balance / dislike of sports
Inability to alternate between looking closely and looking in the distance easily (e.g., copying notes off the board)
Poor spatial awareness (usage of space)
Poor sequencing skills (math / reading / writing)
Poor sense of time (management, difference between yesterday and tomorrow)
Galant Reflex
(In supported prone aka ventral suspension) stroke one side of infants lateral trunk / paraspinals
Trunk should laterally flex toward stimulus
Appears 28 weeks gestation
Integrates 3-6 months
At what point does a delay in the integration of the Galant Reflex become a concern?
Beyond 9 months
Could result in fidgeting / inability to sit still
In a 1 month old, we begin to see reduced effects of ___ ___.
physiological flexion
As extension develops
1 Month Prone
Less UE / hip flexion
More anterior pelvic tilt
Able to lift head momentarily (more active neck extension)
1 Month Supine
Less UE flexion / some reaching / hands fisted
Less LE flexion / reciprocal and symmetric kicking
Head turned to one side (no anti-gravity flexion yet)
1 Month Pull to Sit / Sitting
Pull to Sit:
More pronounced head lag due to loss of physiologic flexion / spine in flexion (c-curve) / flexed at hips
Supported Sitting: Head forward (in line with trunk for short periods and head bobbing) / curved spine (no anti-gravity trunk extension)
2 Months Prone
Less UE flexion / more shoulder abduction
Less LE flexion / pelvis closer to surface
Able to lift head 45 degrees (WB on elbows, elbows behind shoulders)
2 Months Supine
Increased shoulder ER
Decreased hip flexion / decreased hip abduction / decreased hip ER
Increased neck rotation
2 Months Pull to Sit / Sitting
Pull to Sit: Continued head lag and flexion throughout spine
Supported Sitting: Head bob (intermittent head and neck extension) / flexion throughout spine (no anti-gravity trunk extension)
2 Months Standing
Does not accept weight on LEs (appearance of motor incoordination / poor orientation of feet)
3 Months Prone
UE increased abduction
Hip ext / abd / ER
Pelvis flat on surface
Knees flexed / feet together
Able to lift head 90 degrees (upper trunk extension, WB on forearms, elbows in line with shoulders)
3 Months Supine
Hands together resting in midline on chest / some reaching
Hip and knee flexion / abduction / still some ER / heels together
Head in midline (chin tuck - neck flexor activity / less neck rotation - decreased ATNR)
Head Righting
When suspended in a vertical position and tilted slowly side to side, the child will move their head to a vertical position
Trunk flexion
Present at birth / strongest at 3 months
3 Months Pull to Sit / Sitting
Pull to Sit: Asymmetric head lifting / neck flexors work inconsistently with extensors / slight head lag (but improved)
Sitting: Head in midline (shoulder elevation, upper cervical extension) / flexion throughout spine (still not enough trunk extension)
3 Months Standing
Accepts some weight on feet again
Hips abd
Knees in stiff extension
Toes curled (Plantar Reflex)
Automatic walking integrated
4 Months Prone
Scapular adduction with trunk extension
Hip extension and adduction / increased APT with lumbar extension
Head and chest lifted - upper trunk extension / WB on forearms, elbows close to body / may accidentally roll to side-lying
4 Months Supine
Reaching above body in midline / hands to knees (log roll to side-lying)
Increased pelvic control (PPT w/ hands to knees)
Head in midline
4 Months Pull to Sit / Sitting
Pull to Sit: No head lag / assists with upper chest and UE flexion - overflow to abs and LEs
Sitting: Head in midline / holds head steady in supported sitting / flexion at hips / curved spine below point of upper trunk extension
4 Months Standing
Takes more weight on LEs
Can be held by hands instead of chest
Pelvis behind shoulders
Legs may flex or extend
5 months marks the beginnings of ___ and ___.
Lateral WS / Lateral righting reactions of head and trunk
To prepare for postural responses to emerge at 6 months
5 Months Prone
Extended arm WB (WB through hands, pelvis) / WS on forearms with reaching
Hip ext / add / neutral rotation
Head and upper trunk lifted (Swimming: Total spinal extension, movement of UEs and LEs)
5 Months Prone Reaching
WS on forearms
LEs:
*WB Side: Hip ext / add / IR
* Reaching Side: Hip hike / flexion / abd / ER
*Development of LE dissociation
May roll prone to supine
5 Months Supine
Reaching with full shoulder flexion and adduction / elbow, wrist, finger extension; hands to feet
Increased pelvic control / PPT with feet to hands and mouth
Asymmetrical rolling to side-lying (UE and LE dissociation)
5 Months Side-Lying
Lateral flexion of head away from floor
Elongation of WB side (bottom leg: extended and adducted / top leg: flexed and abducted)
5 Months Pull to Sit / Sitting
Pull to Sit: No head lag / increased abdominal control, LE flexion / holds head in line with body / assists with UEs / often will pull to stand
Sitting: Flexion at hips / propping on arms or “high guard” position to stabilize
5 Months Standing
May pull to stand with knee extension and PF
Hips in abd / ER
Hips almost in line with shoulders
Lumbar lordosis
Landau Response / Reflex
Emerges from 3-5 months / lasts up until 12 months
Infants held horizontally in the air in prone (head above horizontal with trunk and extremity extension) / examiner flexes head and hips flex (feet go down)
6 Months Prone
Reach forward with WS on extended arm (shoulder girdle stability / elbow, wrist, finger extension)
Better pelvic control, less anterior tilt
Head and upper trunk lifted - Mature Swimming
6 Months Supine
Reaching bilaterally / transfer objects from one hand to the other
Increased pelvic control / play with legs in the air
Asymmetrical rolling to prone (UE and LE dissociation)
Head: Chin Tuck
6 Months Pull to Sit / Sitting
Pull to Sit: Independent / chin tuck and LE flexion / at half-way point knees extend to prepare to sit
Sitting: Back straight, decreased trunk flexion / PPT / hips flexed, abducted, ER / UEs used for reaching and manipulating / Anterior Protective Extension
Righting vs. Equilibrium
Righting: The act of realigning the head / trunk with each other or with an outside stimulus
Equilibrium: Act of re-establishing balance
The Righting Reactions are organized in the ___ portion of the brain.
midbrain
Anterior Protective Extension
In sitting, gently push forward - arms extend in front to prevent from falling
Usually 1st of protective extensions to emerge
Emerges 6-9 months
Lateral Protective Extension
In sitting, gently push hips laterally - arm extends to prevent from falling
Emerges after Anterior Protective Extension
Emerges 6-9 months
6 Months Standing
Able to stand holding fingers
Full WB on feet / knees locked out initially
Hips abducted
Can bounce up and down with feet on floor
Increased abdominal control and hip extensor activity
7 Months Prone
Quadruped - tummy off the floor / rocks in quadruped
Prone pivots
Belly Crawl
7 Months Supine
Does not like supine - rolls out of it!
7 Months Sitting
Assumes sitting from quadruped
Trunk rotation in sitting
Hands free
Lordosis
Can transition to prone
7 Months Side-Lying
Plays frequently in side-lying
Good Lateral Righting
7 Months Standing
Bears full weight with minimal support
Pulls self to stand
Bounces
UE Parachute
Emerges at 6-7 Months
In prone horizontal (suspension at chest), move child toward surface head first (symmetrical arm extension and abduction)
8 Months Prone
Creeps on hands and knees - primary mode of locomotion
Transitions Quadruped to sitting using lateral righting
8 Months Sitting
Good trunk extension
Decreased LE positional stability
Rotation counter-balanced by sideward protective extension or equilibrium reactions
Sitting to quadruped
8 Months Standing
Pulls to stand through kneeling / half kneeling
Rotates trunk over LEs
Cruises sideways
Stands with one hand held
Walks with two hands held - steppage gait
9 Months Sitting
Increased trunk control
Most functional, versatile position
Utilizes various LE positions
Frequently side-sits using increasing hip mobility / may “W” sit
Posterior Protective Extension
Onset at 9-11 months
In sitting, gently push backwards - arm(s) extend behind to prevent from falling
Last protective reaction to emerge
Anterior Righting
Emerges around 9 months
In sitting, gently pull backward at shoulders - extend head and arms forward to recover balance
9 Months Kneeling
Kneeling: Hip extension incomplete
May move into half-kneeling to play
9 Months Standing / Cruising
Pulls to stand - uses UE (LE more active - goes through half kneeling)
Standing - cruises around furniture
Semi-turns in direction to which they are going
9 Months Supported Walking
Walks with two hands held
Decreased LE abduction / ER
UE fixing for support
10 Months Sitting
Able to long sit
Tailor sitting for stability and easy transition to other positions (hip flexion / abduction / ER)
10 Months Standing
Rises through kneeling and half kneeling
Lowers self from standing - maintains UE support
Reaching for toy with one hand
10 Months Supported Walking
Walks with two hands held
Starting to use some pelvis rotation and more LE stride
Marked trunk extension
11 Months Sitting
Controlled trunk rotation
Varies LE positioning (long sitting / side sitting)
Demonstrates increased hip control; able to use kneeling and half kneeling more
11 Months Standing
Transitions to standing through kneeling / half kneeling / squatting with symmetrical LE extension and trunk elevation
Stands alone - UE use is limited
Demonstrates wide BOS; LE abd
Cruises and reaches for furniture out of reach
11 Months Walking
May attempt unsupported walking
UE fixing
Steppage gait with ER
12 Months Sitting
Engages in a variety of play in sitting
Easily moves in/out of sitting from all positions
12 Months Standing
Rises from floor with legs
No longer needs UEs
Able to weight shift and lift one leg
12 Months Squatting
May use squatting for play
Able to take steps / stop / squat to pick up a toy / re-erect and continue walking
12 Months Unsupported Walking
May attempt unsupported walking
Trunk extension / scapular adduction / wide BOS (LE abduction)
