Lecture 10: Pediatric Perspective Flashcards
How we do develop postural control?
through changes of body mass and strength, development of muscle synergies, sensory system, internal representations relative to perception to action, anticipatory or adaptive mechanism
What is reflex hierarchical theory?
postural control depends on reflexes and their integration
also increasing maturation of CNS
What is dynamic systems theory?
elements of postural control is determined by task and environment
What is the neuronal group selection theory?
our brain can select from a variety of actions and can chose best one for the given task (variation + variability)
What are two phases of variability?
- primary- lots of variation in motor behavior, little adaptability
- secondary- able to select best motor strategy for task due to active experience/trial and error
What is the job of righting reactions?
initiates movement vs gravity
What sense is responsible for labyrinthine RR?
vestibular (corrects body when not upright)
What sense is responsible for body on head and Landau RR?
somato sensory (prone position)
What is job of equilibrium reactions?
keeps COG within BOS
What is timeline for rolling in newborn?
prone to supine- 4 mo
supine to prone- 6-8 months
log roll (segmental)- 9 months
When is prone progression?
birth to 10-13 months
head lift - prone on elbows- quadruped- creeping
How do most US children perform supine to stand?
initially- roll to prone- quad- pull to stand
later- prone- quad- plantigrade-stand
When is static sitting achieved in an infant?
6-8 months, cephalocaudal
What are four stages of static sitting?
- no control of large sway
- attempts to initiate upright
- partial control with large range body sway
- functional control with minimal sway
When will reactive postural control become adult like?
starts at 7-8 months
adult- 7-10 years old
When are first signs of APA seen in newborn?
10-13 months gastrocs working as an internal pert. by 16-17 months these become more consistent
When will APA become adult like?
4-6 years old
When newborns first start balance what sense dominates?
visual but with practice they gain increased somatosensation
What 3 things are required for locomotion?
- progression- with rhythmic stepping pattern
- stability- strength and postural control
- adaptation- to environmental changes
Newborns move arms in legs in womb so why can’t they initially walk?
immature postural control system
What is early stepping behavior?
neonatal stepping, maximal support needed
controlled by central pattern generator, more of a reflex so happens below brainstem
Why does this disappear around 2 months?
dynamic systems theory: body build changes don’t match strength requirements
How do newborns avoid obstacles or adapt to environment?
influenced by both APA and RPA, use vision to change patterns
What age is a new walker generally?
9-15 months
What are common characteristics of early stance phase?
PF at IC, flexed knee, absent push off
force generated by forward trunk lean
What are common characteristics of early aged swing phase?
decreased DF, increased HF, short phase due diminished SLS
What else is common in newborns walking?
high cadence, arms in high guard, wide step width
At age 2 what changes are appearing?
knee flexion wave, push off by end of year 2, reciprocal arm swing
What are changes in years 3-7?
increased SLS, velocity and step length
decreased cadence
Put in order of first to last as they appear: hop, run, skip, gallop?
1- run
2-3 hop or gallop
4- skip (longest SLS)
What is one of best ways to examination a children’s balance?
observation during functional activities like play( know whats appropriate at that age)
What are some clinical exams that can be used with kids?
pedi berg balance, FRT, TUG, DGI, walking obstacle course, 30 sec walk test
What is purpose of pedi berg balance?
best for 6 yrs or younger, for school aged kids with moderate balance, but has ceiling effect
measure change over time
What are norms for pediatric FRT?
5 years- 15.7 cm
9-10 years- 27.17 cm
13-15 years- 32.3 cm
