L6: Atypical Motor Dev. Flashcards
Physio Flexion
Leads to soft tissue tightness where?
- Hip flexion
- ABDuction
- ER
- knee flexion
- ankle DF
Dev. of LE control
Gravity pulls them into ?
Frogged leg pos.
More on gravity
Frogged leg position
- Lumbar EXT + Hip Flex== anterior pelvic tilt (incd ABD and ER)
- APT active 3-4mos
APT active when
3-4mos
Developing LE control
Crucial time developing pelvic mobility how?
Floor and tummy time leading up to hands to knees ~4mos
Floor + tummy time leads up to hands to knees when?
~4mos
Dev. of LE control:
Knees/hands to feet
VERY IMPORTANT!
WHAT PLANE?
Hands to feet== sagittal plane
2 main components to Knees/Hands to feet
Posterior pelvic tilt*
Elongation of HS’s*
More on Knees/Hands to feet
- PPT
- Abd. flexion, LE flexion, ADDuction, ER
- Pelvic mvmt accompanied by LE mvmts→ control around ea jt.
- Elongation of HS’s
- Int. obliques
- body awareness and exploration
Components of Development of LE Control:
4:
- Physio flexion
- Gravity= frogged leg pos.
- Pelvic mobility (floor+tummy time) leads to hands to knees
- Knees/Hands to feet
BIG component to TYPICAL development of LE control
Lateral wt. shift (frontal plane)
TYPICAL Dev. of LE control
Lat. wt shift develops after…..
Sagittal plane control (APT and PPT)
TYPICAL Dev. of LE control
Lateral wt shift
Elongates WB side→ facilitates what?
Elongation of WB side→ facilitates lateral righting of trunk and lateral hiking of pelvis
TYPICAL Dev. of LE control
LE mvmts + ability to what?
LE dissociated mvmts and ability to reach
TYPICAL Dev. of LE control
Active knee flexion and EXT in prone→ explain cascade of events
Active knee flex/ext in prone→ elongates quads→ activates glute max→ pelvic stab. for UE use
Maintenance of frog-legged position represents what ?
Atypical Development of LE
Atypical Dev of LEs
Maintenance of frog-legged position
Results from this:
- Absence of antigravity flexion; Decd postural stab. (no synergistic stab.)
- Unable to post. tilt pelvis to elongate lumbar extensors
- NO hands to feet, unable to lift legs***
- Absence of antigravity hip flex+ADD→ lack of hip ABD elongation
- Lack of pelvic control
Maintenance of Frog legged position
What happens→ Supine?
Legs and anterior pelvic tilt block from moving and achieving any other position.
Stuck and not able to roll/trunk rotate
Maintenance of Frog legged position
What happens→ Prone?
More lateral flexion/army crawling bc NO rotation available for crawling
Atypical development: LEs
Missing components aka
Compensations/”fixing” elsewhere
Prolonged compensations become pathological if never modified
Red Flags
Birth→3mos
- Easy startle response
- Incd stiffness
- Poor head control
- Reliance on head/neck hyperEXT
Red Flags
4-8mos
- HypOtonia
- Mass patterns of mvmt
- Asymmetry
- Limtd variety of mvmt patterns or lack of mvmt
Red Flags
9-12mos
- HypOtonicity
- HypERtonicity
- Poor protective responses
Neurological deficits
2:
- Excessive EXT mm activty
- Inad. development of postural tone
Neuro Deficits
Excessive EXT mm activity
Explain
Antgravity flexion does NOT develop/is NOT strong enough to balance EXTs
Neuro Deficits
Inadequate dev. of postural tone
- Lack of stability for mvmt/mobility
- Infant learns to “fix” in order to gain stability
- “fixing” becomes stronger and “blocks” normal postural dev.
What does “Fixing” limit?
Limits DOF
First step
of skill acquisition
Fixing
Fixing is first step of skill acquisition
explain
- First step of skill acquisition so SHOULD resolve as baby gains incd control
When Fixing does NOT resolve===
Inc stiffness, tone, altered sensory feedback
*fixing in one area == compensations in another
Compensations
-
Functional compensations achieve baby’s goal
- diff. to change UNLESS you help them dev. a better way to achieve same goal
- Sensory feedback altered w/ compensations
- Motor dev. dependent on feedback
altered w/ compensations
Sensory feedback
*Motor dev. dependent on feedback
“Blocks” to Normal Development
3:
- Neck Block
- Shoulder Block
- Pelvic Block
“Blocks”
Neck Block
2 types
- HyperEXT
- Head/Neck Asymmetry
“Blocks”
Neck Block→ HyperEXT
Cause?
- Neck flex does not dev. to balance EXT
- No midline
- no chin tuck
- Use head/neck hyperEXT to lift head
- incd strength of hyperEXT
“Blocks”
Neck Block→ HyperEXT
What baby does?
- Lack of norm head control
- elevates shoulders to stab. head
- exaggerates hyperEXT
- tongue/oral mm’s used to “fix”
“Blocks”
Neck Block → HyperEXT
Results:
- Decd scap mobility→ blocks UE use
- open mouth posture→ protraction of jaw
- Decd head righting→ decd ability to lateral wt shit→ decd abd strength→ decd rib cage mob/stab.
- over elongation capital flexors
- impaired suck for feeding
- impaired coord. of respiration for phonation/sounds
- impaired visual convergence and down. gaze
“Blocks”
Neck Block → Head/Neck Asymmetry
Cause?
- Does develop symmetrical B/L head and neck flexors
- decd midline
- dominated by ATNR***
“Blocks”
Neck Block → Head/Neck Asymmetry
What baby does?
Uses 1 UE for reaching
Uses lateral or uncoord’d ocular mvmts
“Blocks”
Neck Block → Head/Neck Asymmetry
Results?
- Dec visual convergence→ poor visual perception
- Dec BUE use
- Decd body awareness
- Deformities
“Blocks”
Shoulder Block
Cause?
- Dec scap stability
- Lacks forearm WB
- Decd T/S EXT = limits L/S EXT
- Lack dissociation humerus and scap
- Lack shoulder girdle control
“Blocks”
Shoulder Block
What baby does?
- Primitive prone EXT
- Fixing of humerus w/ EXT, ADD, IR
“Blocks”
Shoulder Block
Results:
- Dec reach, grasp, manip.
- Poor UE WB in prone→ limites creep/crawl
- Decd protective EXT/balance rxns and wt shifting onto UE for transitions
- shortened pecs
- reinforced neck hyper EXT & lack of SH flex.
Pelvic Blocks
2 types
APT/hip block
PPT/hip block
“Blocks”
Anterior Pelvic Hip block think….
Maintaining Frog legged position!!!
“Blocks”
Ant. Pelvic Tilt (maint. frog legged pos.)/hip block
Causes:
- APT never balanced w/ PPT due to lack of antigravity flex/Decd postural stab.
- shortened L/S exts
- tight hip ABD’s
- Norm. lower pelvic control NOT dev’d
“Blocks”
Ant. Pelvic Tilt/hip block
What baby does?
- Maint. or fix w/ frog legged pos. to control or prevent wt shift
- Use hip flexion for stability
“Blocks”
Ant. Pelvic Tilt/hip block
Gen. consequences:
- APT and L/S EXT becomes stronger/tighter
- Abnorm wt shifts (shortening of WB side)
- Rely on sag. plane for transitional mvmts
- Poor dev. of hip EXTs
- Poor dissociation of LE
“Blocks”
Ant. Pelvic Tilt/hip block
Results: Supine
- Hip ADDs elongated (bc frog legged pos maint.)
- ABDs+TFL tight
- L/S EXtd
- poor control lumbar flex
- poor dev abdoms
- possible hip disloc.
- Tight HS’s
- dec body awareness
- poor dev. obliques
Blocks
Ant. Pelvic Tilt/hip block
Results: Prone
- Overuse frog legged pos== no lateral wt shifts
- Inc APT
- Incd LS ext
- T12/L1 hypERmobility→ abnorm dissociation bw ribs & pelvis
- No hip Ext= no pelvic stab for UE use
- No LE dissociation= no knee flex=tight quads
Ant. Pelvic Tilt/hip block
Results: Quadruped (attained by symm. flexion of both LEs pulling up under trunk)
- Hip flexors + APT stabilize w/ UE
- No wt shift so Bunny hop for mobility
- Disuse of postural mm== overwork lg mvmt mm’s
Ant. Pelvic Tilt/hip block
Results: Quadruped→Kneeling
- T12/L1 hypERmobilty → APT and hip flexion which inhibits abdoms***
- rib cage moves over pelvis→ stretches obliques
- excessive front. plane mvmt== ineff. wt shift
- diff getting to ½ kneel bc unable to lat. wt shift
Ant. Pelvic Tilt/hip block
Results: Sitting
- unable to keep COM over BOS w/out pelvic/hip control
- W-Sitting**** → stabilizes/locks out pelvis and hip and COM**
-
PROBLEM!:
- hip flex dominance
- rib cage over pelvis
- obliques stretched
- knee flex contractures
- knee hypERmobility
- incd sag. plane mvmt
- dec front/transv plane mvmt
Ant. Pelvic Tilt/hip block
Results: Standing
Typical 6mos
Standing w/ support (sagittal)
Ant. Pelvic Tilt/hip block
Results: Standing
Typical 7-8mos
Cruising (frontal)
Ant. Pelvic Tilt/hip block
Results: Standing
Typical 7-10mos
Rotation (Transverse)
Ant. Pelvic Tilt/hip block
Results: Standing
Typical Dev
- Stand w/ support 6mos→ sagittal
- Cruising 7-8mos→ frontal
- Rotation 7-10mos→ transverse
Ant. Pelvic Tilt/hip block
Results: Standing
Atypical Dev
- Wide BOS
- COM over BOS
- Poor or absent wht shift
- LE ER
- Wt on medial side of feet
- curl toes for stab.
Ant. Pelvic Tilt/hip block
Results: Ambulation
-
Leans whole trunk over WB side to wt shift
- → Crouched gait= contractures/deforms of hips, knees, ankles
- Maints. APT to stab. spine/pelvis over COM
- wide BOS w/ toe out
- flex/ADD of knees to lower COG
- ankle pronated + eversion
Anterior pelvic tilt consequences:
- Contractures/deforms of hips, knees, ankles
- Hip flexors tight or contracture of HS’s
- Develop quickly w/ extensive repetition of compensations in WB
Posterior Pelvic Tilt/Hip Block
Prone
-
Strong LS Ext w/ strong hip ext/ADD
- EXT mm tight and antigrav flexors weak→ hip mobility limtd
Posterior Pelvic Tilt/Hip Block
Sitting
- Shortened mm’s result in limtd mobility
- → Sacral sitting
- abnorm flexion compensation→ W-sitting
- Dec lateral wt shift== dec LE dissociation
Posterior Pelvic Tilt/Hip Block
Standing
- ADD’d legs
- narrow BOS
- PF
- lack postural control for wt shift/LE dissociation
- req’s support to stand
Posterior Pelvic Tilt/Hip Block
Ambulation
- Diff + prob need AD
- Lack of wt shift== “falling” foot to foot
- Adduction== scissoring gait
- Contractures/deforms:
- Limtd ABD ROM
- tendency to PF
- Tip Toe walk (DF really tight)
Define “Midline”
Hands to knees and feet→ HUGE milestone for typ. frontal/transverse dev.***
Fixing occurs when?
W/out flexor/extensor balance, FIXING occurs to achieve functional goals
IF they persist→ they BLOCK typical progression!
Atypical development depends on variety of factors:
- Extent of CNS damage
- Cog status/lvl motivation
- Compensations also depend on therapeutic intervents child has received ***
RED FLAGS***
BIG ONE
-
Regression of skills
- occasionally typ dev children start crawling hands and knees but realize this takes more work than belly crawling; MAY revert back to that for a few days but should NOT see regression for more than that***
RED FLAGS***
Eye contact
Toe Walking
-
Averting eye contact w/ parents and Toe walking emergence
- Never toe walked before, now they are 2 and are toe walking== Big Red Flag for neuro issues
