Lecture 1 Part 2 Flashcards
An embryo becomes a fetus at ___________
8 weeks
First trimester is how many weeks?
What happens?
1-12 weeks
All major body systems are established
Second trimester includes what weeks?
What happens?
13-26 weeks
Body proportions grow to newborn proportions
Third trimester includes what weeks?
What happens?
27-40 (note: so you’re technically pregnant for 10 months)
Body weight triples and body length doubles
Bodyfat accumulates to aid temperature regulation
When are the lungs developed
36 weeks
What is included in the STORCH acronym?
Syphilis
Toxoplasmosis
Other infections (HIV, Coxsackievirus, Varicella-Zoster)
Rubella
CMV
Herpes
Directionally: Typical development goes from ____________ to __________
Cephalic to caudal
Proximal to distal
gross motor to fine motor
What test is used by the delivering medical team to assess the infant
Apgar score
Total score 1-10
Higher the score = better the baby is doing
What is considered premature birth?
What is considered extreme premature?
Past what week will they induce a delivery?
Under 38
Under 28
Over 42
Between what weeks is it normal to give birth
38-42
Describe a newborn posture
UE:
LE:
Head:
UE: Flexion and hands fisted
LE: Flexed w/ highly positioned pelvis
Head: turned to one side
When a newborn is in supine, what posture should you expect
UE:
LE:
Head
UE flexion
LE flexion, abduction, ER
Head turned to one side
If you pull a newborn to a seated position what should you expect to see at their head?
Head lag
When a newborn is seated what kind of posture do they have?
What happens to their head?
Posture - C curve throughout with no anti-gravity extension
Head forward w/ no control and head bobbing
Newborns prefer what kind of color scheme?
At what distance is their vision best?
Strong contrasting colors
Best 8-9 inches away
What happens if a child does not display the normal primitive reflexes
“Involuntary movements eventually become voluntary movements” - meaning that they need reflexes to develop skilled voluntary movement
They will struggle with motor and cognitive skills
If a child retains their primitive reflexes for too long, what can this mean
developmental delays
What activates the flexor withdrawal reflex?
What is the reflex consist of?
A noxious stimulus to the sole of the foot
flexion withdrawal of the leg
When does the flexion withdrawal reflex appear
When does it integrate
At approximately 28 weeks of gestation
integrates at 1-2 months of age
What is the crossed extension reflex?
What triggers it?
Caused by noxious stimuli to the sole of the opposite foot
While one foot withdrawals, the other has extension and adduction
When does the crossed extension reflex first appear
when does it integrate?
28 weeks of gestation
integrates between 1-2 months of age
(same as the flexor withdrawal reflex)
What is the positive support/primary standing reflex?
If you hold a baby up and touch their feet to flat surface, they will extend their legs against the ground for 20-30 seconds
When does the positive support/primary standing reflex first appear
when does it integrate?
appears at 35 weeks gestation
integrates after 1-2 months
What is the automatic walking/ support&stepping reflex
Baby will step reciprocally when inclined forward w/ feet touching a surface
When does the automatic walking reflex first appear?
When does it integrate by?
When does it re-appear?
37 weeks gestation
3-4 months
Re-appears at 10-15 months in preparation for walking
What is the rooting reflex?
Baby turns head and lips towards stimulus to look for breast or bottle
When does the rooting reflex first appear?
When is it integrated by?
28 weeks gestation (Same as an extremely premature birth)
Integrated by 3 months
What is the sucking reflex and the suck-swallow reflex?
Baby will suck bottle&breast /
baby will have rhythmic excursion of jaw
When does the sucking reflex first appear?
When is it integrated by?
28 weeks gestation ( same as an extremely premature birth)
integrated by 3 months
When does the suck-swallow reflex first appear?
when is it integrated?
appears 28-34 weeks gestation
integrates at 5 months
What is the moro reflex
Sudden change in head position in relation to trunk will result in:
crying
flexion, abduction of the shoulders and extension elbows
followed by flexion of the elbows
When does the moro reflex first appear?
When is it integrated by?
28 weeks gestation (same as an extremely premature birth)
integrated by 3-5 months
What is the asymmetric tonic neck reflex?
In supine, turning head causes arm and leg extension, and elbow flexion and leg flexion on opposite side (pointing toward the side you’re facing)
When does ATNR typically appear?
When does the ATNR typically integrate?
Appears at 20 weeks gestation (earliest one)
4-5 months
What is the palmar grasp reflex?
Baby will grasp things placed in it’s palm
When does the palmar grasp reflex typically appear?
When does it integrate?
Appears 25-28 weeks
Integrates (disappears) by 4-7 months of age
What are the 2 phases of the palmar grasp reflex?
- PT strokes palm of infant w/ index finger, infant closes fingers
- The pressure applied to palm produces tractions on the finger tendon leading to clinging action
Integration of what reflex by 6 months typically signifies cortical maturation and a developmental motor milestone
the palmar grasp reflex
Presence of the palmar grasp reflex beyond 7 months is typically present in children with ____________
cerebral palsy
This reflex can also appear in adulthood indicating a cortical lesion
What is the TLR Tonic Labyrinthine Reflex?
Neck extended -> increase in extensor tone
Neck flexed -> increase in flexor tone
When is the TLR reflex first seen, when is it BEST seen?
since birth
3 months
When does the symmetric tonic neck reflex first appear?
When does the symmetric tonic neck reflex integrate
4-6 months
8-12 months
What comes first the STNR or the TLR
TLR birth-3 months
STNR 4 months-12months
What happens in the STNR (symmetric tonic neck reflex)
With head flexion: the arms flex and hips extend
With head extension: arms extend and hips flex
What is the plantar grasp reflex?
Pressure at the sole of the foot, just distal to the toes or in supported standing -»> leads to flexion of toes
When is the plantar gasp reflex typically first present?
When is it integrated?
Present at 28 weeks
integrates by 9 months
When does the palmar grasp reflex integrate?
when does the plantar grasp reflex integrate?
4-7 months
9 months
When does the moro reflex integrate?
When does the ATNR reflex integrate?
When does the TLR reflex integrate?
When does the STNR reflex integrate?
3-5 months
4-5 months
6 months
8-12 months
What is the Galant reflex?
In supported prone (ventral
suspension), stroke one side of the
infants lateral trunk or paraspinals
The trunk should laterally flex
toward the stimulus
Which way does the baby flex toward during the galant reflex? Toward or away from the stimulus?
toward
When does the galant reflex first appear?
When does it integrate?
Appears at 28 weeks gestation
Integrates at 3-6 months
At the one month mark you see reduced effects of physiologic _______________ as ___________ develops
flexion
extension
How should a one month baby look in prone?
UE and LE:
Pelvic:
Head:
LESS UE flexion. Less hip flexion
more anterior pelvic tilt
able to momentarily lift head w/ active neck extension
How old is this baby?
1 month
No head control
some UE flexion and LE flexion
What will you see when a one month old is in supported sitting
Head forward and no consistent midline orientation
curved spine w/ no anti-extension muscle activation
If you pull a 1 month old to sit, what will you see?
still has head lag
Primary standing reflex integrates by ________
Automatic walking reflex integrates by ___________
1-2 months
3-4 months
A Two month old is characterized by decreased ___________ and increased ______________
will they be symmetrical?
Decreased flexion, increased extnesion
not yet symmetrical as extension is not balanced by flexion
A two month old in prone will display what in prone?
UE: more shoulder ___________, less __________
LE:
Head:
Weight bearing:
Less UE flexion, more shoulder abduction
Pelvis closer to surface, Less LE flexion
Head held at 45 degrees, able to lift head
weight bearing on elbows, elbows behind shoulder
How old is this child?
2 months bc they can weight bear on elbows and have more extension
How will a 2 month old present in supine?
Increased shoulder ER,
decreased hip flexion, abduction, ER
Increased neck rotation present w/ ATNR
How old is this child?
2 month old, Bc of increased shoulder ER and lack of hip flex,abd,er
How should a baby look at 2 months during a pull-to-sit
still has headlag and flexion throughout spine
In supported sitting how does a 2 month old look?
intermittent head bob/ neck extension
flexion throughout spine, no anti-gravity extension
Should a 2 month old accept weight when you place their feet on the ground while holding them up?
No, their positive support reflex has already integrated
however they still might have automatic walking
What emerges at 3 months?
Midline orientation (hands together and on chest, feet together)
Symmetry between flexors and extensors
How will a 3 month old present in prone?
UE:
Pelvis:
Head:
Weight bearing:
UE has increased abduction,
Pelvis: flat on surface
head: able to lift to 90
weight bearing on forearms
how old is this baby?
3 months old
-increased UE abduction
able to lift head
At what age will a baby have their hands resting at midline on their chest and heels together in supine
3 months
How old is this baby?
3 months old
-head at midline
-feet together
When you slowily tilt a baby side to side at 3 months, a baby will have ______________ present at their head
head righting
their head will maintain a vertical position
note: present at birth but strongest at 3 months
At what age will a baby have a chin-tuck in supine w/ neck flexor activity
3 months
3 month old pull to sit:
Asymmetric head lifting, but not perfect head lag YET
At what age will a baby have their head in midline at sitting w/ shoulder elevation and cervical extension, however trunk still without anti-gravity extensors
3 months
Will a 3 month old accept weight onto their feet if you hold them up and put their feet on a surface?
Yes they should begin to accept weight on their feet again.
Present at 1 months, disappears at 2 months, present again at 3 months
At what age will a baby have knees stiff in extension during supported standing w/ toes and curled due to plantar reflex
3 months
At what age does a baby have established head control w/ symmetry between flexors and extensors
4 months
how old is this baby!
4 months
How will a 4 month old look in prone?
head:
scapula and trunk:
pelvis:
Head and chest lifted
scapular adduction w/ trunk extension
increased anterior pelvic tilt w/ lumbar extension
may accidently roll to sidelying
At what month can a baby reach above body in midline and bring hands to knees in order to log roll to the side
4 months
What will a 4 month old look like in supine?
increased pelvic control, posterior pelvic tilt w/ hands to knees
head in midline
can reach above midline
At what month is head lag completely gone from a Pull-to-Sit
4 months
baby will have abdominal activation and upper chest/UE flexion in order to assist
What will a 4 month old look like in sitting?
head at midline
holds head steady
curved spine in lumbar but upper-trunk ext present
At what age can a baby stand w/ support at hands
4 months
note: legs may either be flexed or extended
What skills start to develop at 5 months?
Development of lateral weight shift and lateral righting reactions of head and trunk
What will a 5 month old look like in prone?
Weight bearing:
UE:
Swimming?
Able to extend arms and bear weight
weight shift onto forearms w/ reaching
may start swimming AKA total spinal extension w/ movement of UE and LE
At what age will a baby develop disassociation of UE and LE and may roll from prone to supine
5 months
For a 5 month old doing prone reaching, what position is the hips in on the reaching side?
Reaching side: Hip hike, hip flexion, abduction, ER
Weightbearing side: Hip Ext, adduction, ER
What will a 5 month old look like in supine?
Able to bring hands to feet
increased pelvic control
upper and lower extremity disassociation
How old is this baby
5 months
-able to keep lateral flexion of head away from floor
elongation of WB side w/ bottom leg ext+adducted
and top leg flexed and abducted
How will a 5 month old perform in a pull-to-sit
No headlag
increased control of muscles
midline orientation
often will pull to stand
How will a 5 month old look in sitting?
Head at midline
flexion of hips
propping on arms or “high guard” to stabilize
How will a 5 month old look in standing?
Baby may perform __________
Hips:
Hips position w/ shoulders:
Lumbar:
May pull to stand w/ knee ext and plantarflexion
hips in abduction/ER
Hips almost in line w/ shoulders
lumbar lordosis
What does a baby develop at 6 months:
Head control:
Increased control of:
Mature _________ reflex
________ responses emerge
Good head control
increased control of shoulder girdle
mature landau reflex
prone equilibrium reactions present, emerging in supine
Postural responses emerge
What is the Landau response and when does it emerge?
In prone horizontal suspension a baby will have trunk and extremity extension
if examiner flexes the head, the hips will flex
3-5 months, lasts until 12 months
When does the landau response emerge, when does it mature and when does it integrate?
emerges from 3-5
matures at 6
lasts until 12
How old is this baby?
6 months
- exhibiting mature swimming
What can a baby do in prone at 6 months
Reach forward w/ weight shift on extended arm
Shoulder girdle stability
better pelvic control w/ less anterior tilt
head and upper trunk lifted for mature swimming
At what age will a baby be able to reach bilaterally for objects in supine and transfer objects from one hand to another
and is able to play with legs in air
6 months
How old is this baby
6 months, able to perform chintuck in supine
At what age is a baby independent for pull-to-sit and exhibits a chin tuck w/ lower extremity flexion
6 months
how will a six month old look in sitting?
back straight w/ decreased trunk flexion
UE can be used for reaching and manipulating objects
At what age will a baby have anterior protective extension and lateral protective extension?
6-9 months
How old is this baby?
6 months
Where are righting reactions organized in the brain?
midbrain
How to test a babies anterior protective extension?
in sitting gently push baby forward, arms should extend to prevent falling (usually the first protective extension to emerge)
How to test a babies lateral protective extension?
Gently push baby sideways from sitting, arm should extend to prevent falling (emerges after anterior protective extension)
How will a baby look standing at 6 months?
What are they able to do in standing?
Able to stand holding just fingers, full weight bearing on feet
hips are abducted
can bounce up and down with feet on floor
What is the earliest age that this describes:
-Variety of positions and movements
very active against gravity
little time spent in supine
7 months
At what age can a baby perform:
-rocks in quadruped
belly crawl
and prone pivots
7 months
What will supine look like for a 7 month old?
Does not like supine, will roll out of it
What will sitting look like for a 7 month old
assumes sitting from quadruped
trunk rotation n sitting
can sit w/ hands free
What will sidelying look like for a 7 month old?
Plays frequently in sidelying
good lateral righting
What will standing look like for a 7 month old?
Bears weight w/ minimal support
pulls self to stand
can bounce
At what age does the upper extremity parachute reaction emerge?
6-7 months
baby will have symmetrical arm extension and abduction if you tilt a childs head forward toward a surface
What month of development does this describe?
Moves quickly in and out of positions
exploration of environment
plays in supported standing or kneeling
8 months
How old is this baby
8 months
-can creep on hands and knees
transitions from quadruped to sitting using lateral righting
At what month old will a child exhibit:
Good trunk ext in sitting
rotation-counter balanced by sidewards protective extension
8 months
At what month old will a child pull to standing through kneeling/half kneeling
8 months
At what month old can a child cruise sideways?
8 months
At what month old can a child rotate trunk over LE
-Stand w/ only one hand held
-walks w/ steppage gait w/ 2 hands held
8 months
At what age will a baby have a drive to stand and walk?
9 months
What is the primary means of locomotion at 9 months
crawling
What does sitting look like for a 9 month old
Most functional and versatile position
frequently side sits using increased hip mobility
may W-sit
At what age does a child develop the posterior protective extension reaction?
9-11 months
At what age does a baby develop the anterior and lateral protective extension?
What about posterior protective extension?
6-9 months
9-11 months
At what age will a baby develop anterior righting and how do you test it?
in sitting gently pull backwards at the shoulders, baby will extend arms and head to recover forward balance
emerges at 9 months
What will kneeling look like for a 9 month old baby
Hip extension incomplete?? (whatever this means on bickley’s slide IDK)
may move into half kneeling for play
What will a baby look like during standing at 9 months
Uses UE to pull to stand
Can cruise around furniture and semi-turn in direction to which they’re going
What will supported walking look like in a 9 month old?
-can walk w/ 2 hands held
decreased LE abduction and external rotation
At what age will a baby play in-and-out games w/ containers
and have exploration and practice of motor skills
10 months
At what month is a child able to long sit, and has stability in sitting for easy transition to other positions
10 months
What will a 10 month old look like in standing?
Rises through kneeling and half kneeling
lowers self from standing
can reach for toy with one hand
What will a 10 month old look like in supported walking?
Starts to use pelvis rotation and more lower extremity stride
marked trunk extension
still walking w/ 2 hands held
What month old does this describe:
Uses a variety of gross and fine motor skills for play and exploration
beginning of independent standing
enjoys container play, carrying toys, and bi-manual activities
11 months
What month old does this describe:
Demonstrates controlled trunk rotation in sitting
varied LE position, long siting, side sitting
increased hip control able to use kneeling and half kneeling more frequently
11 months
How old is this child?
11 months
What can a child do in standing at 11 months
Can squat symmetrically
Stands alone w/ limited UE use
demonstrates wide BOS
Cruises and reaches for furniture that’s out of reach
At what age may a child attempt unsupported walking?
w/ upper extremity fixing (high guard)
and steppage gait w/ external rotation
11 months
What age does this describe??
Righting reactions well integrated in most movements
equilibrium reactions present in all positions except standing
all basic motor skills present
12 months
How old is this child?
12 months
What can a 12 month old do in standing?
rises from floor w/ legs and no longer needs UE
Able to shift weight and lift one leg
At what age may a child use squatting for play
12 months
What does walking look like for a 12 month old?
Unsupported
w/ trunk extension and scapular adduction, wide base of support
