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developmental concepts > lecture one: development and postural control > Flashcards

lecture one: development and postural control Flashcards

1
Q

stages of development (infancy to early childhood)

A
  • infancy: birth to 1 yr
    - neonatal: birth to 2 wks of age
    - infant: 3 wks to 12 months of age
  • toddlerhood: 13 months to 2 yrs (2 yrs, 11 months)
  • early childhood
    - preschool: 3 yrs to 5 yrs
    - elementary school: 5 yrs to 10 yrs (10 yrs, 11 months)
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2
Q

stages of development (adolescence to young adulthood)

A
  • adolescence: 11 yrs to 18 yrs
  • young adulthood: 18 to 22/25 yrs
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3
Q

stages of development (adulthood to late adulthood)

A
  • adulthood: 22 to 40 yrs
  • middle age: 40 to 65 yrs
  • late adulthood (older adult): 65+ yrs
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4
Q

advanced maternal age (AMA)

A

describes a pregnancy where the mother is older than 35

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5
Q

erik erikson

A

german psychologist who theorized that there is a specific psychological struggle that takes place through eight stages of person’s life

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6
Q

eight stages of development theory

A
  • infancy (0 - 1 yr): basic trust vs mistrust
  • early childhood (1 - 3 yrs): autonomy vs shame
  • play age (3 - 6 yrs): initiative vs guilt
  • school age (6 - 12 yrs): industry vs inferiority
  • adolescence (12 - 19 yrs): identity vs confusion
  • early adulthood (20 - 25 yrs): intimacy vs isolation
  • adulthood (26 - 64 yrs): generativity vs stagnation
  • old age (65 - death): integrity vs despair
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7
Q

postural control

A

involves controlling the body’s position in space for dual purposes of stability and orientation

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8
Q

postural orientation

A

ability to maintain an appropriate relationship between body segments and between body and environment for a task

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9
Q

postural stability (i.e. balance)

A

ability to control center of mass in relationship to base of support

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10
Q

center of mass (COM)

A

a point that is at the center of the total body mass
- just anterior to S2 in upright position
- determined by finding weighted average of COM of each body segment
- key variable that is controlled by postural system

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11
Q

center of gravity

A

vertical projection of COM
- dependent on weight and distribution of weight within the body

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12
Q

center of pressure (COP)

A

center of distribution of total force applied to supporting surface
- moves continuously around COM to keep COM within support base

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13
Q

base of support (BOS)

A

area of body that is in contact with support surface

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14
Q

quiet stance

A

small amount of spontaneous postural sway as the body moves continuously within its BOS

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15
Q

ideal body alignment

A

minimize effect of gravitational forces and maintains equilibrium with least expenditure of internal energy

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16
Q

vertical line of gravity falls in midline between…

A

mastoid process, anterior to shoulder joints, hip joints (or just posterior), anterior to knee joints, anterior to ankle joints

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17
Q

muscle tone

A
  • force to which a muscle resists being lengthened (stiffness)
  • can have too high or too low of muscle tone
  • certain level of muscle tone is present in normal, conscious, and relaxed person
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18
Q

postural tone

A
  • when we stand upright, activity increases in antigravity postural muscles to counteract force of gravity
  • sensory inputs from multiple systems are critical to postural tone
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19
Q

limits of stability

A
  • ability to maintain projected COM within limits of BOS; boundaries within which the body can maintain stability without changing base of support
    *stability limits are not fixed boundaries but change according to the task, characteristics in the individuals, including strength, ROM, characteristics of the COM, and various aspects of the environment based on support
    *both position and velocity of COM need to be considered at any given moment
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20
Q

postural control, stability, and orientation requirements vary with the ____ and ________

A

task, environment

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21
Q

3 types of postural control

A
  1. STEADY STATE CONTROL: ability to control COM relative to BOS in fairly predictable and non changing conditions (i.e. standing quietly, sitting)
  2. REACTIVE CONTROL: occurs in response to outside forces, such as perturbations, displacing COG or moving BOS (i.e. being bumped in a crowd)
  3. PROACTIVE OR ANTICIPATORY CONTROL: occurs in anticipation of internally generated, destabilizing forces, such as the intent to move (i.e. stepping onto a curb)
    *most functional tasks require all three aspects of balance control at some point or another
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22
Q

reactive balance relies on ______ mechanisms

A

feedback
*postural control that occurs in response to sensory feedback from an external perturbation

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23
Q

proactive/anticipatory balance relies on ________ mechanisms

A

feedforward
*anticipatory postural adjustments that are made in anticipation of a voluntary movement that is potentially destabilizing in order to maintain stability during movement

24
Q

four postural movement strategies

A
  • ankle strategy: smaller, slower perturbation
  • hip strategy: larger, faster perturbation
  • stepping strategy: largest, fastest perturbation (more frequent with aging)
  • reach strategy: elicited by a similar perturbation as stepping strategy
25
Q

what are the two primary curvatures?

A

thoracic and sacral (kyphotic curves)

26
Q

what are the two secondary curvatures?

A

cervical and lumbar (lordotic curves)

27
Q

postural reflexes for newborn to 2 months

A
  • PRIMARY STANDING/POSITIVE SUPPORT: in supported standing, first accepts weight on legs for 20-30 sec, then collapses (inability to sustain weight loading condition)
  • AUTOMATIC WALKING: steps reciprocally when inclined forward
28
Q

postural reflexes for newborn to 6 months

A
  • ASYMMETRIC TONIC NECK REFLEX (ATNR, AKA FENCING REFLEX): in supine, head rotation elicits chin side arm/leg extension and skull side arm/leg flexion —> if ATNR does not integrate, developmental coordination disorder (DCD) can develop in adolescence
  • TONIC LABYRINTHINE REFLEX (TLR): neck extends (increased extensor tone and extension of all limbs), neck flexes: increased flexor tone and flexion of all limbs
29
Q

anterior protective extension

A
  • anterior perturbation —> arms extend forward to prevent from falling
  • emerges 6 to 9 months
30
Q

lateral protective extension

A
  • lateral perturbation —> arms extend laterally to prevent from falling
  • emerges 6 to 9 months
31
Q

upper extremity parachute

A
  • in prone horizontal suspension, child is moved towards surface head first —> symmetrical arm extension and abduction
  • emerges 6 to 7 months
32
Q

posterior protective extension

A
  • posterior perturbation —> extends head and arms backward to recover balance
  • emerges 9 months
33
Q

developmental changes for prenatal and newborn

A
  • PRENATAL (25-27 wks): somersaults, axial rotations, flexing, kicking, stretching, and punching
  • NEWBORN (at birth): newborn anatomical characteristics include a proportionately large head relatively shorter legs than trunk and arms, a C curve throughout the spine —> flexion is predominate posture in all limbs
34
Q

independent sitting happens at ____ months

A

six

35
Q

full gestational period is ____ weeks

A

forty

36
Q

developmental changes for infancy (FIRST THREE MONTHS)

A
  • flexed posture dominates —> head tipped forward in supported sitting
  • limb symmetry at first, progressing to asymmetry (begins at 2 months)
  • increase extension of the spine —> begins to lift head in prone (by 2 months)
  • midline orientation (by 3 months) —> i.e. holding a toy at midline
37
Q

developmental changes for infancy (FOUR TO SIX MONTHS)

A
  • on-elbows to on-hands posture
  • spinal extension includes lumbar region (lower spine)
  • head held upright
  • begins hands-knees position from prone (ant-post weight shift)
  • becomes more independent in sitting, once positioned (by 6 months)
  • begins to take weight on legs again in supported stance
38
Q

typical development occurs in a predictable fashion moving from ______ to ______ and ______ to _______

A
  • cephalic to caudal
  • proximal to distal
39
Q

at 4 months, there is no more _____ lag

A

head lag

40
Q

developmental changes in infancy (SEVEN TO NINE MONTHS)

A
  • continues rolling and achieves quadruped position
  • belly crawling to creeping
  • independent, thought wobbly, achievement of sitting posture
  • sitting becomes preferred position for 8 month old
  • improve body-weight shifting skills
  • transitions between postures are readily practiced
  • 7 month olds hate supine position as they are very mobile
41
Q

developmental changes in infancy (TEN TO TWELVE MONTHS)

A
  • vertical postures now preferred by child
  • with newly erect posture, toddler stance often includes lumbar lordosis and protruding abdomen
  • pulls to standing at first, then begins to stand up without pulling
  • walking: early steps with wide base of support and arms in “high guard” —> shoulder rotated outward and elbow flexed —> gradually lowering arm positions and achieve swing patterns 5-6 months after walking onset
42
Q

developmental changes in early childhood (TWO TO SIX YEARS)

A
  • exaggerated lordosis and protruding abdomen begins to disappear
  • percentage of body fat steadily decreases from 22% at age one year to about 12.5-15% at age five years
  • increased muscle tone and decreased body fat give child appearance of being more lean and muscular
    *reference slide 30 for actions
43
Q

developmental changes in middle childhood (SEVEN TO TWELVE YEARS)

A
  • improved transitional movements and improved symmetry
  • gait fully matures at 7 years old
  • by age 10 adult skills are being refined and mastered
  • standing postural patterns emerge —> ectomorphs and mesomorphs
44
Q

ectomorphs

A
  • passive stance, slouched posture
  • small bone structure
  • thin —> hard to gain weight
  • lean muscle mass and flat chest
45
Q

mesomorphs

A
  • active, more military posture
  • strong, athletic, hard body with well defined muscles
  • gain muscle easily and gain fat more easily than ectomorphs
46
Q

stance control in childhood: STATIC BALANCE

A
  • more difficult for children
  • higher center of mass (T12)
  • faster sway rate (reaches adult levels from 9-16 years)
47
Q

stance control in childhood: POSTURAL RESPONSES TO PERTURBATIONS

A
  • 2 to 3 yrs: well organized but amplitudes larger and latencies longer than adult
  • 4 to 6 yrs: responses become slower and more variable
  • 7 to 10 yrs: essentially like those of an adult
48
Q

stance control in childhood: SENSORY ADAPTATION

A
  • 4 to 6 yrs: larger sway, very little reliance on vestibular system and more on somatosensory system
  • vestibular system doesn’t fully mature until 12 yrs of age
49
Q

stance control in childhood: ANTICIPATORY CONTROL

A
  • 12 to 15 months: able to activate postural muscles prior to arm movements
  • adult like postural control not fully developed until 7 yrs of age
50
Q

developmental changes in adolescence

A
  • ideal posture develops —> less abdominal protrusion, less knee hyperextension, head and shoulders well aligned
  • transitional movements —> most symmetrical during this age period, peak of control at 15 yrs
51
Q

developmental changes in adulthood

A
  • standing posture: maintenance of ideal posture
  • transitional movement
    *symmetry reduced: only 1/4 of young adults rise with symmetry
    *asymmetry of at least one body segment develops
    *body size may be determining factor: tall, slender women are more symmetrical than short, heavy women
    *activity level has also been linked to symmetry of performance
52
Q

developmental changes in older adulthood: postural changes (“stooped” or flexed posture)

A
  • widened base of support
  • slightly flexed knees and hips
  • trunk forward lean or protuberant abdomen
  • reduced lumbar lordosis
  • increased thoracic kyphosis: associated with decreased strength of spinal extensor muscles, impaired balance, slower walking and stair climbing, and shorter functional reach
  • forward head
  • loss of spinal flexibility and decreased ROM: spinal extension shows greatest decline (50% less extensor flexibility in 70-84 yr olds as compared to 20-29 yr olds)
53
Q

developmental changes in older adulthood: transitional movements

A
  • revert to more asymmetric postures
    *supine, side-lying, hands-knees, half-kneeling
    *increased time moving between positions (like young children)
  • contributing factors to impaired transitional movements
    *decreased balance, strength, flexibility, and confidence
    *decreased activity
54
Q

developmental changes in older adulthood: musculoskeletal changes

A
  • decreased strength, endurance, and muscle mass
    *LE muscular strength reduced by 40% between ages 30-80
  • decreased number of type I and II muscle fibers
  • decreased number of motor units
  • muscles fatigue more rapidly
  • decreased spine and ankle joint ROM as well as postural shift back onto heels
55
Q

developmental changes in older adulthood: balance and postural changes

A
  • increased sway in quiet stance
  • reduced functional stability limits
  • increased use of hip movements as opposed to ankle movements to regain balance
  • altered anticipatory posture abilities due to delayed muscle onset times (not enough time for stabilizing postural response but prime mover is activated more slowly as well)
  • altered response strategy due to muscle weakness, reduced ankle-joint sensation, and joint stiffness
56
Q

developmental changes in older adulthood: cognitive changes

A
  • decreased attentional capacity, especially during multitasking
  • among frail older adults, inability to walk while talking (dual task involving gait and secondary cognitive task) is predictor of future falls

developmental concepts (7 decks)

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