Lecture 1: normal development in infancy

Question 1

Tools utilised

Answer 1

• Prechtl’s General Movements Assessment- used neonatal and 12 week
• AIMS assessment (Alberta Infant Motor Scale)- 3 months to walking age

Question 2

Pretchl’s GMA

Answer 2

• Assessment of videos in pre-term, term and young infant stages
• General movements are spontaneous, lesions = abnormal general movement
• Strong predictor of cerebral palsy

Question 3

Writhing period

Answer 3

• Normal = variability, complexity and fluency

* Abnormal = lack of variability, complexity and fluency

Question 4

Fidgety period

Answer 4

• Normal = small movements of moderate speed and variable acceleration
• Neck, trunk, limbs
• Abnormal = absence of these movements

Question 5

Pretchl’s GMA evidence

Answer 5

• Absence of fidgety movement highly indicative of CP (98%)

* Presence of cramped-synchronized writhing highly predictive of spastic CP development

Question 6

Asymmetric tonic neck reflex

Answer 6

• Infant can normally overcome reflex after 3 months

* Sustained ATNR that cannot be overcome is indicative of abnormal neuro development

Question 7

Acquiring balance

Answer 7

• Step 1: hold head up with trunk support
• Step 2: propping with arms while sitting
• Step 3: sitting independently without arm support
• Step 4: independent stance

Question 8

AIMS

Answer 8

• 10-20 min observational assessment
• Measures motor skills from term to walking
• 58 items divided among 4 subscales: prone, supine, sitting, standing
• Scores converted into percentile ranks

Question 9

Normal gross movement 3 months

Answer 9

• Prone = elbows behind shoulders, unsustained head raise to 45 deg
• Supine = head/hands to midline
• Sitting = supported, head in midline, pull to sit
• Standing = supported, weight on feet and toes, head in line, hips behind shoulders, hips flexed and abducted

Question 10

Normal gross 6 months

Answer 10

• Prone = elbows in front shoulders, push up on extended arms
• Supine = hands to feet, active extension
• Sitting = supported, sitting with arm support
• Standing = supported, weight on feet and toes, head in line, hips behind shoulders

Question 11

Normal gross 9 months

Answer 11

• Prone = pivoting, reaching, rolling, 4 point, propped on side, starting to crawl
• Supine = rolling to prone with rotation
• Sitting = independent, starting to transition into 4 point kneel
• Standing = pulling to stand

Question 12

Normal gross 12 months

Answer 12

• Prone = crawling with mature patterning, flat lumbar
• Supine = rolling
• Sitting = transition from sit to prone
• Standing = cruising with rotation, standing alone, stepping and standing from quadruped/modified squat

Question 13

Early gait

Answer 13

• Excessive muscle activation due to weak muscles and poor postural control
• Strong co-contraction
• Slightly squatted
• Lean forward to propel body forward
• Flat foot
• Wide but short step
• Arms held high
• Short swing phase
• Balance control: increases velocity and step length, double support phase decreases

Question 14

Early phase of walking

Answer 14

• Balance difficulties
• Rigid halting leg action
• Short steps
• Flat feet
• Toes turned outward
• Wide base of support
• Flexed knee at contact followed by fast leg extension

Question 15

Intermediate stage of walking

Answer 15

• Gradual smoothening of pattern
• Increase step length
• Heel-toe contact
• Arms at sides with limited swing
• Out toeing reduced
• Increased pelvic tilt
• BOS within lateral dimensions of trunk

Question 16

Mature stage

Answer 16

• Arm swing
• Narrow base of support
• Relaxed elongated gait
• Definite heel-toe contact
• Compensatory postural responses during gait cycle
• Increased stability during gait