Lecture 5 Flashcards
postural reactions occur as a response to
the experience of gravity
sequential
across cultures, despite individual differences
timing may differ but it still occurs within the same order
cephalocaudal
development occurs from head to foot
proximodistally
development occurs from proximal to distal
proximal stability leads to distal mobility
stability & mobility
the relationship between these is postural control
proximal stability leads to distal mobility
sensory input affects motor output
first movements are reflexive, initiated by sensation & become voluntary with experience (foundation for all motor & development control
how does hand development occur????
ulnarly to radially
refinement occurs as development goes further distally
why ulnar grasp occurs first & why babies use WHOLE hand to palm something
somatosensory
body scheme – internal sensory system
includes: tactile, proprioception, vestibular
tactile
touch — light touch
proprioception
unconscious awareness of sensation coming from one’s joints, muscles, tendons & ligaments “the positioning sense”
activated by movement – using force
ex of dysfunction: maddie picks up water cup too fast & it spills everywhere
vestibular
sensory input received by the inner ear, regarding: head position, movement & balance
coordinated movement
- responsible for sense of arousal – why we rock a baby to sleep
- responsible for 2 handed crossing of midline
sight @ 1 month
- discerning faces (1 mo old babies can distinguish momma face from strangers
sight at 3 months
baby can distinguish momma from stranger based on face alone
pupils react to light
bright lights appear to be unpleasant to newborn
allows object in line of vision
sight during the first couple of months (colors)
can distinguish patterns
respond to blacks & reds
sight @ 5 or 6 months
babies can discern colors
sight at 6 months
baby can see a few feet away (20/100)
sight at 8 months
baby can see across room (20/60)
depth perception – visual cliff experiment
3 month old babies
heartbeat decreases at ledge —
this can conclude that babies don’t understand the concept of depth perception at this point
depth perception – visual cliff experiment – 6 month old babies
heartbeat increases at ledge — babies would not cross it, although some did when momma prompted them too
THIS SHOWS WE HAVE DEPTH PERCEPTION!
when are ordinary sounds heard
in utero — well before 10 days of life
newborn responds to sounds by
crying
eye movement
stopping activity – startle reaction
sounds @ 1 month old
babies distinguish between the smallest variations in sound
sounds @ 6 months old
development of ability to understand and make sounds necessary for language structure
smell @ 1 day old
distinguish between some smells
smell milk @ nipple
smell at 1.5 months old
infants can distinguish smell of mother vs strangers
leave something with mommas smell on it keep baby comfy
taste – newborns taste preferences
prefer sweet & salty —
dislike bitter tasting things
taste development in utero
lick placenta wall - maybe helped to develop a sense of taste at birth
touch & babies
born with well developed sense of touch — overtime they use this most
- primary means of exploration
- most developed sense @ birth
- greatest sensitivity at fingertips/mouth
- provides internal information regarding the self & continues to body image
reflex
predictable stereotyped involuntary response to a given stimulus
the cerebellum is where
sensory integration occurs
cerebrum is where
voluntary control of cognitive center & the need to build the best controlled movement
primitive reflexes
predictable motor behaviors present at birth
1) SPECIFIC DURATION- emerge in utero…inhibited/cntrld by higher brain centers at 6-12 months to allow for more sophisticated neural structures to develop — allows for voluntary motor control —–correlates with the acquisition of motor skills
2) SPECIFIC FUNCTION- survival, protection, nutrition, subsequent motor dev
3) CAUSE FOR CONCERN WHEN IRREGULAR
- neurological integrity
Assessment of primitive reflex
tool for: diagnosis, treatment planning, measuring progress
stimulate primitive reflexes & look at expected response
infant assessment of primitive reflexes
not present, asymmetrical, may be indicative of CNS insult/pathology (leision, structural problem etc)
AT 1 YEAR IF PRIMITIVE REFLEX IS NOT INTEGRATED (still present) that may suggest
1) CNS pathology - (CP, leison, structural problem)
2) neurodevelopment delay- (NDD, processing immaturatity- ADHD, ASD, LD, dyslexia)
persistence of primitive reflex will limit
volitional motor control – atypical motor behavior patterns (coordination/posture), impede motor (strength/refinement) and sensory development, affect development of postural reflexes – cause immature patterns to remain prevalent
BOTTOM UP treatment of primitive reflexes
remediation!!
- facilitate typical movement patterns –> inhibit reflexes & improve motor control to achieve functional skill/performance
- knowing what reflex is retained helps therapist make sense of functional limitations, plan for appropriate treatment activities
FIX FOUNDATIONAL ISSUE
TOP DOWN treatment of primitive reflexes
task modification!!
use a retained reflex to perform a functional skill
more common with CNS pathologies
ex: have a child with CP bunny hop for mobility
progression of treating primitive reflexes
we can easily re-evaluate for the presence of a reflex
– progress is based on decreased reflex intensity, complete reflex integration, improved volitional motor control
palmar grasp - what does it look like & typical age
palm is stimulated
- 4 fingers not the thumb close
duration - 5 months gestation & 4 months postpartum
function of palmar grasp
survival - hold onto parent in case of danger
concerns w palmar grasp
no palmar grasp - indicative of neurological problems
persists after 4 months old- impact grasp patterns & fine motor coordination - also causes oral motor overflow
assessment of palmar grasp
stimulate palm= look for finger movements
rooting reflex - what does it look like & typical age
touch cheek– baby turns head towards stimuli
starts 24-28 wks gestation until baby is 3 to 4 months old
function of rooting reflex
- nutrition/feeding
conditions baby to turn towards food once they have head control - co-occurs with the sucking reflex
concerns associated with rooting reflex
absence of this: impedes nutrition/feeding
- sign of CNS or sensorimotor dysfunction
if this reflex doesn’t go away after normal dev– may result in immature oral muscle development, & it will impact: swallowing/drooling, feeding, speech, articulation, manual dexterity
movements of the mouth cause
movements of the hand
moro reflex – what it looks like & what age it occurs at
- stimulated by sudden, unexpected occurrence of any kind (light, sound, touch, movement)
- startle - body extension, inhalation, followed by flexion & exhalation (crying)
- duration - 9 to 32 weeks gestation until 2-4 months old
function of the moro reflex
protection- facilitates 1st breath at birth, opens windpipe in case suffocation threat, acts as primitive flight or flight response
begins building middling, awareness of self to others
what replaces the moro reflex
the adult startle reflex
flexion away from source of threat
concerns of moro reflex if the reflex is retained:
- high arousal SMD
- hypersensitity
- hyperreactivity
- poor impulse control
- lack of habituation/can’t ignore periphery
- sensory overload
- anxiety (due to stress hormones presence)
- stimuus bound/heightened state of alert
- labile emotions
- emotional social maturity
- poor adaptability
- allergies and poor immune function
vestibular activated position- PATIENT ASSESSMENT FOR MORO
POSITION standing in bodybuilder position - hands up, elbows, wrists, fingers flexed
PROCEDURE move head backwards
EXPECTATION maintain body builder position
DEFICIT startle, arm extension, protect head in space, gravitational insecurity rigidity, anxiety
spinal galant reflex — what it looks like and the duration it occurs during
- stimulated by tapping parallel to the spine
- lateral trunk flexion & hip rotation towards the stimulated side
- duration 20 wks utero to 3 to 9 months old
function of the spinal galant reflex
may assist birthing process
concerns of spinal galant
retained: easily stimulated by pants or the back of a chair making it difficult for the child to sit still
unilateral retainment= postural asymmetries will occur
tonic labyrinthine reflex (TLR) what does it look like?? how long duration??
- stimulated by a change in head position
- TLR forwards - head flexion w/ body flexion (fetal position) (12wks in utero - 3 to 4 mo old)
- TLR backwards- head extension w/body extension (present at birth – integrates gradually between 6 wks old & 3 y/o)
function of TLR
primitive response to gravity
helps develop the extremes of flexor and extensor tone, postural stability & balance STNR & landau help integrated this reflex
concerns of TLR
if retained it impacts posture (stooped, toe walking - causes an anterior visual shift), balance (otoliths) imedes spatial and perceptual development, muscle tone, head righting (impairs eye movements), motion sickness
TLR assessment
ability to assume antigravity flexion/extension without head going into floor
in standing - look up/down without knees flexing/extending
ATNR – what does it look like? duration of time???
- stimulated in prone/supine/quadruped – turning the head to the side
- then the limbs flex on the skull side and extending on face side
lack of control over body…. especially at distal extremities
function of ATNR
facilitates movement in utero, assists in birth process, develops one sided body movement, ensures a free airway if placed on tummy, trains hand eye coordination, facilitates lateral weight shifts & bilateral body awareness
FACILITATES HAND EYE COORDINATION*
concerns of ATNR
balance crossing midline/mixed hand dominance bilateral integration visual motor skills handwriting horizontal tracking IE READING, AND WRITING CROOKED visual midline crossing convergence
horizontal tracking
common with ATNR ABNORMAL
- left eye can follow left hand and right eye can follow right eye
STNR
stimulated in quadruped - flex or extend neck
in response:
flex neck- which causes arms to flex & legs to extend
extend neck- which causes arms to extend and legs to flex
STNR duration
emerges at 6-9 months once the TLR is integrative
inhibited at 9 - 11 months once crawling occurs
STNR function
helps infant to defy gravity and get into quadruped
breaks up TLR - train mergence and vertical tracking
concerns with STNR
- prevents crawling on hands and knees (scooting instead)
- decreases development of hand arches and upper body strength
decreased pelvic & shoulder stability
decreased reciprocal bilateral skills
poor posture/slump at desk
lie on desk
poor binocular adjustments
difficulty copying from afar
poor upper/lower body coordination
poor convergence/divergence
visual midline crossing
postural reactions
- automatic response to sensory input that act to keep the body parts in alignment, adjusting ourselves against gravity when shifting off center, preventing injury
- PERSIST THROUGH LIFE
- essential to dynamic and static balance
children w/o volition control of the body
are exhausted at school
difficulty processing school work
while trying to inhibit their reflexes when they are integrated & why it relates to volitional motor development
righting reactions
adjustment of the head & trunk
automatic postural responses elicited by sensory input that signals that the head or trunk is not in midline
labyrinthine righting reaction
stimulus- sitting or in vertical suspension - tilt the child gently from side to side or front to back
- the head will move in the direction opposite of the tilt to maintain the head in line with body
- 0 to 2 months old this emerges
purpose= optical righting reaction needed to orient to space when rolling, sitting, creeping, walking
body on head righting reaction
stimulus- touch and proprioception when body is on support surface (supine or tummy time)
response- head vertical mouth horizontal
purpose: prevent suffocation - provides head control for sitting, crawling, locomotion
age- birth to 2 months
matures by 4-5 months prone & 5-6 months supine
neck on body righting reaction
stimulus- in supine: rotate child’s head to one side
response- body rotates w/ dissociation (SEPERATE PARTS MOVING) & segmental rotation head–>neck–>UE–>LE
- — this correlates with certain muscle development
age: 4-6 months
integration- 5 y/o
purpose- organized oration around body axis - baby can roll from supine to prone
body on body righting
stimulus- supine flex & rotate child’s hip to one side
response- child rotates: pelvis –> UE –>head & rolls over to align body
age- 4-5 mo
integration- 5 yrs
purpose- body alignment - 2-3 y/o child uses sidesit to get up - 4-5 y/o child no longer needs to do sidesit therefore this reaction isn’t useful at 5
landau reflex
body righting in a sagittal plane
stimulus- support child in prone. horizontal with hands under thorax – observe head, back and legs
response- neck & back extension, LE extension/abduction, scapular retraction, forearm pronation
age- 3 to 4 mo integration- 12 to 24 mo
purpose- breaks up flexion dominance, assists in head extension & postural transition
PROTECTIVE REACTIONS extension of limbs when balance is challenged is
- there to break/prevent fall
- elicited by vestibular input that signals a change in head position
- reactions are delayed or absent in persons with severe disabgilities
protective extension forward reaction
stimulus- support child @ thorax, plunge head & arms down and forward
response- shoulder flexion, elbow extension, wrist extension, finger extension & abduction, positive supporting once contact made
age- 6-9 mo persists (prep for crawling/unilateral weight bearing)
purpose- protection, WB on UE, coincides w ability to reach forward & WB on arms
protective extension sideways
stimulus- sitting perturb/ push child sideways, or watch child play
responsE- extension @ elbow, abduction of shoulder, extension & abudction of fingers
age - 7 to 9 months
purpose- prevent sideways falling & allows sitting w/o support
protective extension backwards
STIMULUS- child sitting w/ legs in front, push him backwards
RESPONSE- extension of shoulders/elbows w extension & abduction of fingers
AGE- 9-10 months & persists on
PURPOSE= Prevent falling backwards, sitting w/o support
equilibrium reactions are defined as
automatic, compensatory postural adjustments that occur in order to restore the center of gravity within the base of support
equilibrium reactions - stim, response, age, purpose
STIMULUS- tilt child’s support surface to one side, then to the other. can be tested in any position
RESPONSE- move in the direction that will stop falling
AGE- changes based on the position tested in
PURPOSE- maintain posture & prevent falling
neurodevelopment motor delays may be apparent IF: SUMMARYYY
1) Primitive reflexes don’t appear in the first year of life
2) Primitive reflexes appear but do not disappear by end of first year
3) postural reactions do not appear by end of first year
4) postural reactions do not persist throughout life
head control occurs at what age
6 months
newborn gross motor development
- reflexive movements dominate
- physiological flexion
- poor head control
- assymetric rhythmic alternating limb movements
- total boy movements into flex/ext
- distal isolated random movements
- prone lifts head slightly
1-2 mo gross motor development
- purposeful movement of arms & legs
- in prone lift head to 45 deg
- in supported sitting, holds head erect briefly
3 mo gross motor development
- functional head/neck control emerges
- bring hand to body from abduction
- prone: prop forearm w sustained head elevation - reflexively falls with neck flexion
no functional play position
supine: tucks chin
sitting: requires upper trunk support
fine motor: open/close hand, put obj in hand
4 mo gross motor development
age of symmetry (midline control)
gain abdominal & paraspinal strength –> brings about lateral flexion
4 mo gross motor development – prone
extension patterns develop
pivot prone = superman position (landau), head 90 deg in midline & forearms pronated &wrist slightly extended... fingers are loosely flexed forearm weight bearing with controlled neck flexion accidental rolling (prone-->supine)
4 mo gross motor development – supine
bring hands to midline, roll to side laying when flexed & head turns
- side lying is important b/c
- —-weightbearing and gravity activate obliques & shape rib cage
- —-new visual orientation
- — new vestibular orientation
- — asymmetric tactile & prop input
4 mo gross motor development – sitting
sits 10-15 min w lower trunk support
4 mo gross motor development – fine motor
brings hands together in midline and plays with fingers, swats at objects and grasps objects w both hands
5 mo gross motor development – prone
center of gravity shifts caudally (bc glut development)
weight bearing thru humerus (proximal stability)
weight shifts for face-side reaching
5 mo gross motor development – supine
lifts head
accidental rolling supine to side lying (b/c there is no control of flexors thanks to TLR)
5 mo gross motor development – sitting
sits erect w support
5 mo gross motor development – fine motor
grasp objects w/ left or right whole hand (palmar grasp) hold lone object while looking at another
6 mo gross motor development – prone
lifts chest & upper abdomen off floor, moves self on floor, plays with a variety of forearm positions
6 mo gross motor development – supine
holds arms & legs vertically may roll to prone, pull to sit without head lag
6 mo gross motor development – sitting
sits independly w UE support
may sit briefly w/o support but easily falls
6 mo gross motor development – standing
bounces around
6 mo gross motor development – fine motor
full voluntary palmar grasp holds bottle
7 mo gross motor development
- prone: crawling; may begin to assume quadruped
- supine: sufficient antigravity flexion to play with feet; rolls over 360 deg
- sitting: ring sitting emerges; sit –> prone
- standing: pull to stand & bear-standing emerges
8 mo gross motor development
- crawling: many diff acceptable variations
- reciprocal extremity movements
- forearm pronation/supination w play
- trunk rotation & midline crossing emerge
- long sitting & ring sitting combine, narrowing the BOS
ring sitting & w sitting combine to produce side sitting — wide stable base of support & allow for rotation and midline crossing
9 mo gross motor development
- kneeling, tall kneeling, half kneeling
- w sitting (typical @ 9 mo, as long as child uses variety of positions — w sitting IS NOT BAD)
10 mo gross motor development
- sits from side lying
- creeps up stairs
- efficient crawler & climber demonstrating coordination btwn trunk/extremities & an emerging body awareness/perceptual skills with improved environmental navigation
- kneeling w/o external support
- standing w one hand support
- lower from standing to squatting due to incr control of leg muscles
- walking w 1 hand, uses exaggerated trunk ext while walking
- swing phase of gait - characterized by extreme hip & knee flexion, followed by lumbar & knee extension
11 mo gross motor development
cruising- walking holding furniture
- controlled sitting for extended time w spinal lateral flexion & narrowed BOS
- squatting & trying to rise w/o hand support
- enhanced quad & hip control facilitate climbing onto furniture and controlled lower to squat
- standing w/o support
- improved unsupported walking
12 mo gross motor development
- quiet sitting w/ fine motor tasks
- baby may still crawl for speed
- climbing is activity of choice
- independent walking
red flags for infant development
- unable to sit alone by 9 mo
- unable to transfer objects from 1 hand to other by 1 year
- abnormal pincer grip/grasp by 15 mo
- unable to walk alone by 18 mo
- failure to speak recognizable words by 2
WORRY WHEN MULTIPLE MILESTONES ARE NOT BEING MET!
