lecture 1: part 2 new born and primitve reflexes Flashcards
what are the 3 periods that gestation is divide into and how long is it
first trimester: weeks 1-12
second: weeks 13-26
third: weeks 27-40
when during gestation development is all major body systems established
first trimester: weeks 1-12
what happens during the second trimester (weeks 13-26
body proportion grow to newborn proportions
what happens during the 3rd trimester: weeks 27-40
body weight ___
body length ___
body fat accumulates (helps w body ___)
@ ___ weeks the lungs are developed
body weight triples
body length doubles
body fat accumulates (helps w body temperature)
@ 36 weeks the lungs are developed
at how many weeks do the lungs become developed
36 weeks
when is a baby considered an embryo
first 8 weeks
when is a baby considered a fetus
8weeks until birth (40 weeks full gestation)
when is full gestation
40 weeks
what are common detrimental environmental influences on the perinatal that could influence development
STORCH
tobacco
smoke
alcohol
caffeine
drugs
what is STORCH
Syphillis
Toxoplasmosis
Other infections (HIV, Coxsackievirus, Varicella-Zoster Virus)
Rubella
CMV
Herpes
what is teh typical development of a child dependent on (3 )
Nervous system maturation
Genetics
Environment
what are the directional typical development
Cephalo-caudal (head to toe)
Proximal to distal
Gross motor to fine motor
what are 3 things that a newborn needs to do
breathe , suck and swallow
what is the apgar score
test performed by delivering medical team to assess the infant
when is the apgar score delivered at
1 minute and 5 min and 10 minutes (if needed)
the apgar score is based on a total score of what
1 to 10 ( the higher the score , the better the baby is doing after birth
when is a new born , born
38-42 weeks (40 weeks is full term)
when is an infant considered premature? extreme premature
< 37 weeks
<28 weeks
what does a new born look like
head proportionately larger with short LEs
kyphotic, horizontal ribs
what is the ROM differences for a newborn
excessive DF
30° flexion contracture at hips and knees
what is a new born dominated by
flexion anf lack of antigravity mm control
In PRONE , how is the newborns UE , LE and head
UE flexion, held to
body, hands fisted
LE flexion, highly
positioned pelvis
Head: turned to
one side
In SUPINE , how is the newborns UE , LE and head
UE flexion
LE flexion,
abduction,
external rotation
Head: turned to
one side
-No anti-gravity neck flexion so
unable to hold in midline
During a pull to sit in a new born how is the head , what is present thruough the C curve and at the hips
head lag
flexion throughout C curve
flexed at hips
Pertaining to a NEWBORN, how is the head and C curve during SITTING
head forward: no control and head bobbing
C curve with flexion - no antigravity extension
what colors do a NEWBORN see
black and white
pertaining to a NEWBORN , is it easiest to fixate on a moving object ___ and ____
laterally and vertically
newborns prefer strong ___ colors
contracts at 8-9 inches away
what’s are primitive reflexes
involuntary motions that aid in the development of certain skills
As the baby’s brain matures and goes through
typically development these primitive reflexes and
associated involuntary movements should be
replaced with ___ ones.
voluntary
As the child’s CNS matures, the involuntary movements become controlled motor responses. If this doesn’t happen, the child will struggle with both ____ and ___ skills.
motor and cognitive
A 2018 study by Gieyztor, et al. suggested that preschool children who retained the ___ and ____ reflexes had difficulty with motor skills
TLR and ATNR
The same study of 35 children concluded that children with an unintegrated ___ reflex showed poor posture, poor eye-hand coordination, and focusing difficulties. They also had difficulty sitting still at a desk, learning to swim, and playing ball games. Ditto for children who retained the plantar, palmer, and Galant reflexes.
ATNR
An unintegrated ATNR reflex could have
an adverse affect that may also lead to what?
poor eye
tracking
Asymmetrical tonic neck reflex (ATNR)
- weeks of gestation that it appears:
- integrates:
- stimulus
-response:
- weeks of gestation that it appears: 20
- integrates: 4-5 months
- stimulus: turning of head
-response: facial arm extends and abducts , opposite arm flexes and abducts
Rooting reflex
- weeks of gestation that it appears:
- integrates:
- stimulus
-response:
- weeks of gestation that it appears: 28 weeks
- integrates: 3 months
- stimulus: touch to perioral area of hungry infant
-response: turns head and lips toward stimulus
Suck-swallow
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
- weeks of gestation that it appears: 28-34 weeks
- integrates: 5 months
- stimulus: touch to lips and inside mouth for suckling and liquid for swallowing
-response: rhythm is excursions of jaw
Palmar grasp
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
- weeks of gestation that it appears: 28 weeks
- integrates: 4-7 months
- stimulus: pressure on palm of hand
-response: flexion of fingers
plantar grasp
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
- weeks of gestation that it appears: 28 weeks
- integrates: 9 months
- stimulus: supported standing on feet or pressure to sole fo the foot just distal to MT head
-response: flexion of toes
flexor withdrawal
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 28
- integrates:1-2 months
- stimulus: noxious stimulus to sole of foot
-response: flexion withdrawal of leg
crossed extension
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 28 weeks
- integrates: 1-2 months
- stimulus : noxious stimulus to sole of foot
-response: flexion of stimulated leg and then extension of opposite leg with adduction
Galant (trunk incurvation)
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 28 weeks
- integrates: 3 months
- stimulus: in prone , stroke paravetebral skin
-response: lateral curvature of trunk on stimulated side
Moro
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 28 weeks
- integrates: 3-5 months
- stimulus: head drop backwards ( stimulate for the startle reflex is loud noise with same response)
-response: abduction and extension of arms , splaying of fingers , may be followed by arm flexing and adduction
positive support
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 35 weeks
- integrates: 1-2 months
- stimulus: ball of feet in contact with firm surface
-response: legs extend to support weight
automatic walking/ reflex stepping
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 37 weeks
- integrates: 3-4 months
- stimulus : hold upright with feet on support
-response: high stepping movements with regular rhythm
Symmetrical tonic neck reflex (STNR)
-weeks of gestation that it appears:
- integrates:
- stimulus
-response:
-weeks of gestation that it appears: 4-6 months after full term delivery
- integrates: 8-12 months
- stimulus: flexion or extension of head
-response: with head flexion , arms flex and hip extend , with head extension arms extend and hips flex
during a positive support/ primary stnading reflex how long will the bay extend his legs before flexing his legs and collapsing into a sitting position
20-30 seconds
when does teh stepping/automatic walking reflex re appears at
10-15 months
when does the sucking reflex appear and integrate
appear around 28 weeks of gestation
integrated by 3 months
when does the moro reflex start to integrate by
3 month s
he palmar grasp reflex is a primitive, ____ response to a mechanical stimulus present in a newborn.
involuntary
what does the integration of the palmar grasp reflex signifies
cortical maturation and the development of voluntary motor milestones
a weak response to the palmar grasps before 6 months or even after 7 months can be possible injury to what
peripheral nerve (root, plexus , or SC)
persistence of the palmar grasp reflex beyond 7 months is usually present in children
with what ?
spastic cerebral palsy.
the palmar grasp reflex can also reappear in adulthood, indicating a ___ ___
affecting the ____ or ____ frontal cortex (e.g., ischemic or hemorrhagic
stroke)
cortical lesion
medial or lateral
when is the tonic labyrinthine reflex present and integrated by
present at birth and integrated by 6 months
Tonic Labyrinthine Reflex (TLR) , tone in prone and supine ?
Prone – infant with greater flexion tone
Supine – infant with greater extension tone
for the Tonic Labyrinthine Reflex (TLR) when the neck is extended what is increased ? what about when the neck is flexed ?
-Neck extended: Increased
extensor tone and extension
of all limbs.
Neck flexed: Increased
flexor tone and flexion of all
limbs
when is the Tonic Labyrinthine Reflex (TLR) best seen at
3 months
are Tonic Labyrinthine Reflex (TLR) and symmetrical tonic neck reflex the same
NOOOOO w tonic u are holding baby
if the Galant reflex does not integrate by 9 months what may result in a problem be with
inability to sit still
what is the big development at one month
reduced effects of physiologic flexion as extension develops
for ONE month PRONE there is less what and what does the head do
less UE flexion , hip flexion , more anterior pelvic tilt
Head: able to lift
head momentarily
More active neck extension
for ONE month supine there is less what and what does the head do
less UE flexion , some reaching , hands fisted
less LE flexion reciprocal symmetric kicking
head is turned to one side (no anti gravity flexion yet)
during a ONE month old pull to sit is more pronounced head lag due to what and what is the spine and hips in
due to loss for physiologic flexion
spine and hips in flexion
how is the head and curved spine in supported sitting for a ONE month old
head forward
curved spine: no anti gravity trunk end tension
What is a 2 month old baby characterized by
Decreased flexion dominance
Increased extension
Asymmetry: extension not balanced by
flexion
Describe what 2 month baby in PRONE would look like (UE. LE, head) where do they weight bear?
Less UE flexion , more shoulder abduction
Less LE flexion , pelvis closer to surface
Head: able to lift head 45°
WB on elbows , elbows behind shoulders
In a 2 month old baby in SUPINE what is increased and decreased? what reflect is present
increased shoulder ER
increased neck rotation
decreased hip flexion , abduction and ER
ATNR present with neck rotation (integrated at 4-6 months)
how is the head and spine during a pull to sit in a 2 month old baby
Continued head lag
and flexion throughout
the spine
describe supported sitting in a 2 month old baby
head bob
flexion thru spine; no antigravity trunk extension
at 2 months do babies have anti gravity trunk extension
no
what reflex is integrated at 2 months
positive support/ primary standing
for a 2 month old baby in stnading do they accept weight thru their LE
NO
what is the typical emergence for a baby at 3 months
emergency of symmetry and balance of neck flexors and extensors
emergence of midline orientation
body awareness
how is the UE , LE and head for a 3 month baby in PRONE?
UE increased abduction
hip extension , abduction , ER , pelvis flat on surface , knee flexed , feet together
head is able to lift 90° - upper trunk extension
where do babies WB in PRONE as a 3 month old
on forearms - elbows in line with shoulders
when does the babies hands come together , resting in midline on chest with some reaching
3 months
how is the LE and head for a 3 month old baby in SUPINE
hip and knee flexion , abduction , still some ER , heels together
HEAD is in midline - chin tuck - neck flexor activities
at what age do babies begin to chin tuck
3 months
what is head righting ? and when is it the strongest
When suspended in a vertical position and tilted slowly side to side, the child will move their head to a vertical position
strongest at 3 months
describe what a pull to sit looks like for a 3 months old
asymmetric head lifting
neck flexors work inconsistently with extensors
describe what a sitting looks like for a 3 months old
Head in midline: shoulder elevation and upper cervical extension
Flexion throughout the spine: still not enough trunk extension
what is the standing position for a 3 month old
some weight on feet again
hip abducted
knees in stiff extension
toes curled (plantar reflex)
when is automatic walking integrated
at 3 months
what is the simple overview for a 4 months old
symmetry and balance good between flexors and extensors
good head control
describe how a baby is when PRONE at 4 months ( UE < LE < Head)
scapular adduction w trunk extension
hip extension and adduction , increased anterior pelvic tilt with lumbar extension
head and chest lifted
where does the baby WB in prone at 4 months
on forearms , elbows close to body
when may a baby accidentally roll over to their sides
4 mths
when does a bay start reaching above body in midline , hands to knees
4 months
how is a baby laying in supine at 4 months
increased pelvic control , postieror pelvic tilt with hands to knees
head in midline
how is the babies pull to sit at 4 months of age
no head lag
assists to sit with upper chest and UE flexion , overflow to abs and LE
at what age does a baby not have anymore head lag when going from pull to sit
4 months
how is the head , hips and spine for a baby sitting at 4 months
head in midline
hips flexed
curved spine below point of upper trunk extension
how is the baby standing at 4 months
can be held by hands instead of chest
pelvis behind shoulders
les nay be flex or extend
when does a baby develope very beginnings of lateral weight shift and lateral righting reactions
of head and trunk
5 months
how is the baby positioned in PRONE at 5 months
____ arm WB
weight shift on ____ with reaching
hip ____ and ____
____ and ___ trunk lifted
extended arm WB
weight shift on forearms with reaching
hip extension and adduction
head and upper trunk lifted
what is “swimming” and when does it start
total spinal extension ,movement of UE and LE
start at 5 months
when a baby is PRONE reaching at 5 months how is the weight bearing side and reaching side of the LE positioned ? and what is developed
Weight bearing side: hip extension, adduction, IR
Reaching side: hip hike, hip flexion, abduction, external rotation
Development of lower extremity dissociation
when ,may a baby roll prone to supine
5 months
how is the baby reaching in SUPINE at 5 months
reaching w full shoulder flexion and adduction , elbow , wrist and finger extension - hands to feet
when does a baby have increased pelvic control , posteiror pelvic tilt with feet to hands and mouth
5 months
when does a baby do asymmetrical rolling to sidelying ?
5 months
UE and LE dissociation
how is the baby positioned in sidelying at 5 months
lateral flexion of head away from floor
elongation of WB side -
how is the babies LE positioned during SIDELYING at 5 months
bottom leg: extended and adducted
top leg: flexed and abducted
No head lag
Increased
abdominal
control, increased
LE flexion
Holds head in line
with body
Assists with upper
extremities
what month does this pull to sit describe
5 months
how is the baby sitting at 5 months
head in midline
flexion at hips , propping on arms or high guard position to stabilize
how is the baby standing at 5 months
may pull to stand with knee extension and PF
hips in abduction adn ER
hips almost in line w shoulder
lumbar lordosis
when dos the mature landau response occur
6 months
when do postural responses emerge
6 months
Good head control in all directions
Increased control of shoulder girdle
Mature Landau response
Prone equilibrium reactions, emerging
in supine
Postural responses emerge
this overview describes a baby at how many months
6
what is the landau response
in prone , horizontal suspension , head is above horizontal with trunk and extremity extension
examiner flexed the neck and hips so the feet go down
when does the landau reflex emerge and last till
3-5 months and last until 12 months
how is a 6 month old baby in PRONE and what matures
reaches foward w weight shift on extended arm
- shoulder girdle stability
- elbow, wrist and finger extension
less anterior tilts
“mature swimming”
how is the baby reaching in SUPINE at 6 months
bilaterally , transfers objects from one hand to another
head: chin tuck
how is the babies head in SUPINE at 6 months
in chin tuck
when can a bay pull to sit independently
6 months
how is the baby sitting at 6 months (spine , hips , what protective extension)
back straight
PPT , hips flexed, abducted and ER
UE used for reaching
anterior protective extension
where is righting reactions organized
in midbrain
what is the righting reaction
beings able to realign the head or trunk with each other w an outside stimulus
when is usually the first of the protective extensions to emerge and when
anterior protective extension around 6-9 months
what is the anterior protective extension
when the baby is in sitting and u push them foward their arms should extend in front to prevent from falling
what protective extension usually comes after anterior protective extension and when does it emerge
lateral protective extension and around 6-9 months
what is the lateral protective extension
when the baby is in sitting and u push their hips laterally and their arms should extend to prevent from falling
how is the baby stnading at 6 months old
able to stand holding fingers
full WB on feet
hips abducted
can bounce up and down with feet on floor
when is a baby able to stand by holding fingers
6 months
Variety of positions and
movements
Very active against gravity
Little time spent in supine
what age does this overview describe
7 months
how is the baby positioned in PRONE at 7 months
quadruped - tummy off the floor
rocks in quadruped
belly crawl
when does a baby not line supine anymore and rolls out of it
7 months
when does a baby develope trunk rotation in sitting and assumes sitting from quadruped
7 months
how does a baby frequently play at 7 months
in sidelying
how is the baby stnading at 7 months
minimal support
pulls self to stand
what is upper extremity parachute and when does it emerge
baby is prone horizontal at the chest , you move child toward surface head first and the baby shoudl have symmetrical arm extension and abduction
‘
emerges at 6-7 months
when does a baby start to play in supported standing or kneeling
8 months
8 months PRONE :
what is the primary mode of locomotion and how does the baby transition from quadruped to sitting
hands and knees
uses lateral righting
Good trunk
extension
Decreased lower
extremity positional stability
Rotation-counter
balanced by sideward
protective extension or
equilibrium reactions
Sitting to quadruped
this deszcribes what age of sitting
8 months
how does a baby stand at 8 months
pulls to stand through kneeling , half kneeling
rotated trunk over LE
cruses sideways
stnading with one hand held
when can a bay stand with one hand held
8 months
when is crawling the primary means of locomotion
9 months
when is sitting the MOST functional versatile position
9 months
would we rather a baby side sit or w sit
side sit
what is the last protective extension to emerge and when does it emerge
postieor
9-11 months
what is anterior righting and when does it emerge
when the baby is sitting , phill them back on shoulder and the baby shoudl extend head and arms foward to recorder balance
around 9 months
how is the baby kneeling at 9 months
hip extension incomplete
may move to hal kneeling to play
how does a baby pull to stand at 9 months
uses UE
cruises around furniture
how is. a baby doing supported walking at 9 months
walks with 2 hand held
decreased LE abduction and ER
what is the 10 months overview
exploration and practice of motor skills
plays in and out games with containers
when is a bay able to long sit
10 months
how does a baby sit for stability at 10 onths
tailor sitting (hip flexion ,abduction and ER)
when does a baby start to lower self form standing and reaching for toy with one hand
10 months
what is the overview for 11 mon this
enjoys container play , carrying toys and BI manual activites
beginning of independent standing
at 11 months of sitting the baby demonstrated controlled trunk ____ and ____ hip control ; able to use kneeling and half kneeing more
rotation
increased
how is the baby standing at 11 months
stands alone - no UE
wide BOS and LE abduction
squatting
when does a bay attempt unsupported walking
at 11 months
how is the baby walking at 11 months
upper extermity fixing
steppage gait with ER
what is the overview at 12 moths
right reactions are integrated
equilibrium reactions present in all positions except standing
basic motor skills present
at 12 onths equilibrium reactions are present in all positions except what ?
stranding
how is the baby sitting at 12 months
rises from floor with legs - no long needs UE and able to weight shift and lift one leg
when may a bay use squatting to play
12 months
how is the baby unsupported walking at 12 months
trunk extension
scapular adduction
wide BOS
