lab 1: reflexes/positions 0-12 months Flashcards
first trimester is when ____
all major systems established
week 1-12
2nd trimester is when ___
week 13-26
body proportions grow to newborn proportions
third trimester is when ___
week 27-40
body weight 3x
body length 2x
body fat acumulates, for temp regulation
at __ weeks, lungs are developed
36 weeks
embryo is from
0-8 weeks
fetus is from __ to __
8 weeks to birth (40 weeks)
STORCH stands for
Syphilis
Toxoplasmosis
OTHER (HIV, coxsackie virus, varicella-zoster)
Rubella
CMV
Herpes Simplex Virus
directional typical development
- cephalo-caudal
- prox to distal
- gross to fine motor
What is the Apgar score?
test performed by delivering medical team to assess infant
-delivered at 1 minute, 5 minute, 10 minutes after birth
-5 sections, scored 0-2
-based on total score of 1-10 (higher is better)
NEWBORN BODY:
38-42 weeks
1. big head, short LEs
2. kyphotic, horizontal ribs
3. excess DF, 30 flexion hip and knee contractures
4. PHYSIOLOGICAL FLEXION, no antigravity mm control
newborn: prone
UE
LE
Head
UE flexion held to body, fisted hands
LE flexion highly positioned pelvis
head turned to one side
newborn in supine
UE flexion
LE flexion, abduction, ER
head to one side
*no midline head
newborn: pull to sit
HEAD LAG
flexion (c curve spine)
flexed hips
newborn in sitting
head forward, no control and head bobbing
c-curve with flexion throughout spine
no anti gravity extension
newborn vision
easiest to fixate on moving object laterally and vertically (side to side, up and down)
*PREFER STRONG CONTRAST
best vision at 8-9 inches away
flexor withdrawal reflex:
appears:
integrates:
stimulus:
response:
appears: 28 weeks gestation
integrates: 1-2 months
stimulus: noxious stim to sole of foot
response: flexion withdrawal of leg
crossed extension reflex
appears:
integrates:
stimulus:
response:
appears: 28 weeks gest
integrates: inconsistent, about 1-2 months of age
stimulus: noxious stim to sole of foot
response: flexion of stimulated leg, extension of opposite leg w/ adduction
positive support/primary standing reflex
appears:
integrates:
stimulus:
response:
hold baby under arms/support head, touch feet to flat surface. extend 20-30 sec before collapsing
appears: 35 weeks gest
integrates: 1-2 months
stimulus: hold baby under arms/support head, touch feet to flat surface.
response: extends legs 20-30 sec before flexing then collapsing into sitting
support and stepping/automatic walking reflex
appears:
integrates:
stimulus:
response:
appears: 37 weeks gest
integrates: 3-4 months
stimulus/response: steps reciprocally when inclined forward
*REAPPEARS AT 10-15 MONTHS TO PREP FOR WALKING
when does stepping/automatic walking reflex reappear?
integrates 3-4 months
re-appears 10-15 months for walking!
rooting reflex
appears:
integrates:
stimulus:
response:
appears: 28 weeks gest
integrates: 3 months
stimulus: stroke cheek in supine
response: turns head/lips towards stimulus (rooting)
sucking reflex
appears: around 28 weeks gestation
integrates: by 3 months
stimulus: supine, bottle or knuckler
response: baby sucks symmetrically, strong
suck-swallow reflex
appears:
integrates:
stimulus:
response:
appears: 28-34 weeks
integrates: voluntary at 5 months
stimulus: bottle
response: rhythmic excursion of jaw
moro reflex
appears: 28 weeks
integrates: 3-5 months
stimulus: sudden change in head position in relation to trunk (extension)
response: STARTLE reflex -> crying
>flexion, abd of shoulders and ext elbows, then
> ext, add of shoulders and flexion of elbows
ATNR: asymmetric tonic neck reflex
FENCER
appears: 20 weeks
integrates: 4-5 mo
stimulus: head rotation in supine
response: arm and leg extension to face side, arm and leg flexion to back of head side
Palmar grasp reflex
appears: 28 weeks of gest
integrates: by 4-7 months
stimulus: supine, stroke palm/pressure to palm
response: finger closure and clinging (traction on fingers tendon due to pressure at palm)
palmar grasp reflex is integrated typically by…
4-7 months, typically 6 MONTHS
*weak reflex before 6 mo = maybe peripheral nerve injury (root, plexus, SC)
or lasting after 7 mo = abnormality, usually present in SPASTIC CEREBRAL PALSY
persistent palmar grasp reflex in children beyond 7 months is usually in what population?
kids with spastic CP
what reflex can reappear in adulthood, indicating cortical lesion affecting medial or lateral frontal cortex? (ischemic/hemorrhagic stroke)
palmar grasp reflex
tonic labyrinthine reflex (TLR)
appears: at birth, BEST SEEN AT 3 MONTHS
integrates: by 6 months
stimulus: neck extension –> everything extends, neck flexion, everything flexes
response:
If TLR is not integrated,
-poor balance
-poor posture
-skinny/mm tone
-visual problems (far and close)
-spatial problems knowing where body is in space
-maybe poor time management, understanding time
(from youtube video)
Symmetrical Tonic Neck Reflex (STNR)
appears: 4-6 months
integrates: 8-12 months
*should be gone by 12 mo
head flexion: arms flex, hips extend
head extension: arms ext, hips flex
STNR kinda inhibits ___ to help baby with crawling/creeping and then later standing
TLR (integrates first, then STNR)
plantar grasp
appears: 28 weeks gest
integrates: 9 months
stimulus: pressure to sole of foot, just distal to met heads OR SUPPORTED STANDING
response: toe flexion
galant reflex
appears: 28 weeks
integrates: 3-6 months
*def by 9 months
stimulus:
supported prone, stroke one side of lateral trunk/paraspinals
response: lateral flexion towards stimulus
if galant reflex is not integrated by 9 months, what could happen?
problems later, like fidgeting, inability to sit still
involuntary motions that aid
in the development of certain skills in babies.
primitive reflexes
If involuntary movements do not become controlled motor responses as child’s CNS matures, what happens?
child will struggle with motor and cognitive skills
children retaining ___ and ____ reflexes had
difficulty with motor skills such as running, cycling,
throwing, or catching a ball.
TLR and ATNR
unintegrated ___ reflex: showed poor posture,
poor eye-hand coordination, and focusing difficulties.
STNR
one month old prone
less UE flexion, less hip flexion, more APT
ABLE TO LIFT HEAD BRIEFLY
one month supine
less UE flexion
some reaching, hands fisted
less LE flexion
reciprocal, symmetric kicking
head to one side, no flexion yet
one month old pull to sit
head lag
in sitting, head bobbing, no trunk extension
in 2 month old:
decreased ___ dominance
increased ____
extension ____ by flexion
Decreased flexion dominance
Increased extension
Asymmetry: extension NOT balanced by flexion
2 month prone
less UE flexion, MORE ABDUCTION
less LE flexion, pelvis closer to surface
head 45 degree lift
WB on elbows, elbows behind shoulders
2 month supine
more UE ER
less HIP FABER
more neck rotation (ATNR present)
2 month pull to sit
head lag
head bob with intermittent head/neck extension
no trunk extension
2 month standing
NO WB on LEs
What big thing happens at 3 months?
symmetry of neck flexors/extensors
midline orientation
hands together (body aware)
3 months prone
UE abduction, WB ON FOREARMS
pelvis FLAT on surface
head able to lift to 90 degrees
3 month old supine
head midline
chin tuck
hands together
HEELS TOGETHER
when you tilt a child side to side in a vertical position, head will right. What month?
3 months
What will a 3 month old look like in standing?
accepts some weight on feet again
knees stiff in extension
four month old in prone
scap adduction, trunk extension
increased APT with lumbar extension
4 month old in supine
hands to knees, log roll to side lying
more pelvic control, PPT
head in midline
four month old pull to sit
*NO HEAD LAG
5 month old prone
swimming
extended arm weight bearing
WS on forearms w reaching, LE dissociation
*may roll prone to supine
5 month supine
feet to hands and mouth, more pelvic control
UE + LE dissociation
