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Pediatrics > L6: Atypical Motor Dev. > Flashcards

L6: Atypical Motor Dev. Flashcards

1
Q

Physio Flexion

Leads to soft tissue tightness where?

A
  • Hip flexion
  • ABDuction
  • ER
  • knee flexion
  • ankle DF
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2
Q

Dev. of LE control

Gravity pulls them into ?

A

Frogged leg pos.

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3
Q

More on gravity

Frogged leg position

A
  • Lumbar EXT + Hip Flex== anterior pelvic tilt (incd ABD and ER)
  • APT active 3-4mos
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4
Q

APT active when

A

3-4mos

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5
Q

Developing LE control

Crucial time developing pelvic mobility how?

A

Floor and tummy time leading up to hands to knees ~4mos

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6
Q

Floor + tummy time leads up to hands to knees when?

A

~4mos

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7
Q

Dev. of LE control:

Knees/hands to feet

VERY IMPORTANT!

WHAT PLANE?

A

Hands to feet== sagittal plane

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8
Q

2 main components to Knees/Hands to feet

A

Posterior pelvic tilt*

Elongation of HS’s*

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9
Q

More on Knees/Hands to feet

A
  • 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
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10
Q

Components of Development of LE Control:

4:

A
  1. Physio flexion
  2. Gravity= frogged leg pos.
  3. Pelvic mobility (floor+tummy time) leads to hands to knees
  4. Knees/Hands to feet
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11
Q

BIG component to TYPICAL development of LE control

A

Lateral wt. shift (frontal plane)

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12
Q

TYPICAL Dev. of LE control

Lat. wt shift develops after…..

A

Sagittal plane control (APT and PPT)

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13
Q

TYPICAL Dev. of LE control

Lateral wt shift

Elongates WB side→ facilitates what?

A

Elongation of WB side→ facilitates lateral righting of trunk and lateral hiking of pelvis

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14
Q

TYPICAL Dev. of LE control

LE mvmts + ability to what?

A

LE dissociated mvmts and ability to reach

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15
Q

TYPICAL Dev. of LE control

Active knee flexion and EXT in prone→ explain cascade of events

A

Active knee flex/ext in prone→ elongates quads→ activates glute max→ pelvic stab. for UE use

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16
Q

Maintenance of frog-legged position represents what ?

A

Atypical Development of LE

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17
Q

Atypical Dev of LEs

Maintenance of frog-legged position

Results from this:

A
  • 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
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18
Q

Maintenance of Frog legged position

What happens→ Supine?

A

Legs and anterior pelvic tilt block from moving and achieving any other position.

Stuck and not able to roll/trunk rotate

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19
Q

Maintenance of Frog legged position

What happens→ Prone?

A

More lateral flexion/army crawling bc NO rotation available for crawling

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20
Q

Atypical development: LEs

Missing components aka

A

Compensations/”fixing” elsewhere

Prolonged compensations become pathological if never modified

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21
Q

Red Flags

Birth→3mos

A
  • Easy startle response
  • Incd stiffness
  • Poor head control
  • Reliance on head/neck hyperEXT
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22
Q

Red Flags

4-8mos

A
  • HypOtonia
  • Mass patterns of mvmt
  • Asymmetry
  • Limtd variety of mvmt patterns or lack of mvmt
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23
Q

Red Flags

9-12mos

A
  • HypOtonicity
  • HypERtonicity
  • Poor protective responses
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24
Q

Neurological deficits

2:

A
  1. Excessive EXT mm activty
  2. Inad. development of postural tone
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25
Q

Neuro Deficits

Excessive EXT mm activity

Explain

A

Antgravity flexion does NOT develop/is NOT strong enough to balance EXTs

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26
Q

Neuro Deficits

Inadequate dev. of postural tone

A
  • Lack of stability for mvmt/mobility
  • Infant learns to “fix” in order to gain stability
    • “fixing” becomes stronger and “blocks” normal postural dev.
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27
Q

What does “Fixing” limit?

A

Limits DOF

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28
Q

First step

of skill acquisition

A

Fixing

29
Q

Fixing is first step of skill acquisition

explain

A
  • First step of skill acquisition so SHOULD resolve as baby gains incd control
30
Q

When Fixing does NOT resolve===

A

Inc stiffness, tone, altered sensory feedback

*fixing in one area == compensations in another

31
Q

Compensations

A
  • 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
32
Q

altered w/ compensations

A

Sensory feedback

*Motor dev. dependent on feedback

33
Q

“Blocks” to Normal Development

3:

A
  1. Neck Block
  2. Shoulder Block
  3. Pelvic Block
34
Q

“Blocks”

Neck Block

2 types

A
  1. HyperEXT
  2. Head/Neck Asymmetry
35
Q

“Blocks”

Neck Block→ HyperEXT

Cause?

A
  • Neck flex does not dev. to balance EXT
  • No midline
  • no chin tuck
  • Use head/neck hyperEXT to lift head
  • incd strength of hyperEXT
36
Q

“Blocks”

Neck Block→ HyperEXT

What baby does?

A
  • Lack of norm head control
  • elevates shoulders to stab. head
  • exaggerates hyperEXT
  • tongue/oral mm’s used to “fix”
37
Q

“Blocks”

Neck Block → HyperEXT

Results:

A
  • 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
38
Q

“Blocks”

Neck Block → Head/Neck Asymmetry

Cause?

A
  • Does develop symmetrical B/L head and neck flexors
  • decd midline
  • dominated by ATNR***
39
Q

“Blocks”

Neck Block → Head/Neck Asymmetry

What baby does?

A

Uses 1 UE for reaching

Uses lateral or uncoord’d ocular mvmts

40
Q

“Blocks”

Neck Block → Head/Neck Asymmetry

Results?

A
  • Dec visual convergence→ poor visual perception
  • Dec BUE use
  • Decd body awareness
  • Deformities
41
Q

“Blocks”

Shoulder Block

Cause?

A
  • Dec scap stability
  • Lacks forearm WB
  • Decd T/S EXT = limits L/S EXT
  • Lack dissociation humerus and scap
  • Lack shoulder girdle control
42
Q

“Blocks”

Shoulder Block

What baby does?

A
  • Primitive prone EXT
  • Fixing of humerus w/ EXT, ADD, IR
43
Q

“Blocks”

Shoulder Block

Results:

A
  • 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.
44
Q

Pelvic Blocks

2 types

A

APT/hip block

PPT/hip block

45
Q

“Blocks”

Anterior Pelvic Hip block think….

A

Maintaining Frog legged position!!!

46
Q

“Blocks”

Ant. Pelvic Tilt (maint. frog legged pos.)/hip block

Causes:

A
  • 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
47
Q

“Blocks”

Ant. Pelvic Tilt/hip block

What baby does?

A
  • Maint. or fix w/ frog legged pos. to control or prevent wt shift
  • Use hip flexion for stability
48
Q

“Blocks”

Ant. Pelvic Tilt/hip block

Gen. consequences:

A
  • 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
49
Q

“Blocks”

Ant. Pelvic Tilt/hip block

Results: Supine

A
  • 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
50
Q

Blocks

Ant. Pelvic Tilt/hip block

Results: Prone

A
  • 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
51
Q

Ant. Pelvic Tilt/hip block

Results: Quadruped (attained by symm. flexion of both LEs pulling up under trunk)

A
  • Hip flexors + APT stabilize w/ UE
  • No wt shift so Bunny hop for mobility
  • Disuse of postural mm== overwork lg mvmt mm’s
52
Q

Ant. Pelvic Tilt/hip block

Results: Quadruped→Kneeling

A
  • 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
53
Q

Ant. Pelvic Tilt/hip block

Results: Sitting

A
  • 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
54
Q

Ant. Pelvic Tilt/hip block

Results: Standing

Typical 6mos

A

Standing w/ support (sagittal)

55
Q

Ant. Pelvic Tilt/hip block

Results: Standing

Typical 7-8mos

A

Cruising (frontal)

56
Q

Ant. Pelvic Tilt/hip block

Results: Standing

Typical 7-10mos

A

Rotation (Transverse)

57
Q

Ant. Pelvic Tilt/hip block

Results: Standing

Typical Dev

A
  • Stand w/ support 6mos→ sagittal
  • Cruising 7-8mos→ frontal
  • Rotation 7-10mos→ transverse
58
Q

Ant. Pelvic Tilt/hip block

Results: Standing

Atypical Dev

A
  • Wide BOS
  • COM over BOS
  • Poor or absent wht shift
  • LE ER
  • Wt on medial side of feet
  • curl toes for stab.
59
Q

Ant. Pelvic Tilt/hip block

Results: Ambulation

A
  • 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
60
Q

Anterior pelvic tilt consequences:

A
  • Contractures/deforms of hips, knees, ankles
    • Hip flexors tight or contracture of HS’s
  • Develop quickly w/ extensive repetition of compensations in WB
61
Q

Posterior Pelvic Tilt/Hip Block

Prone

A
  • Strong LS Ext w/ strong hip ext/ADD
    • EXT mm tight and antigrav flexors weak→ hip mobility limtd
62
Q

Posterior Pelvic Tilt/Hip Block

Sitting

A
  • Shortened mm’s result in limtd mobility
    • → Sacral sitting
    • abnorm flexion compensation→ W-sitting
    • Dec lateral wt shift== dec LE dissociation
63
Q

Posterior Pelvic Tilt/Hip Block

Standing

A
  • ADD’d legs
  • narrow BOS
  • PF
  • lack postural control for wt shift/LE dissociation
  • req’s support to stand
64
Q

Posterior Pelvic Tilt/Hip Block

Ambulation

A
  • 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)
65
Q

Define “Midline”

A

Hands to knees and feet→ HUGE milestone for typ. frontal/transverse dev.***

66
Q

Fixing occurs when?

A

W/out flexor/extensor balance, FIXING occurs to achieve functional goals

IF they persist→ they BLOCK typical progression!

67
Q

Atypical development depends on variety of factors:

A
  • Extent of CNS damage
  • Cog status/lvl motivation
  • Compensations also depend on therapeutic intervents child has received ***
68
Q

RED FLAGS***

BIG ONE

A
  • 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***
69
Q

RED FLAGS***

Eye contact

Toe Walking

A
  • 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

Pediatrics (27 decks)

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