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Outpatient (Cerebral Palsy) > MC Content - Milestones & Reflexes > Flashcards

MC Content - Milestones & Reflexes Flashcards

1
Q

Differentiate between growth & development

A

Growth = cells divide & grow in number. Quantitive measure ie height/weight
Development = myelination of our nervous system. Qualitative measurement eg can they socialise, follow commands, share a toy, etc

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2
Q

What are the periods of growth?

A

Prenatal - Before birth (Ovum, embryo & foetus)
Perinatal - 22 weeks of gestation to 7 days after birth
Post-natal - Young infant (3-6 months), older infant (7-11 months), Toddler (12-24 months), pre-schooler (3-5 years), etc

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3
Q

Chronological age vs corrected age

A

Chronological = age from their DOB
Corrected = Number of weeks from DOB - number of weeks the baby was premature (assume 40 weeks is full gestation)

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4
Q

True or false: A babies birthweight is a key indicator of infant health?

A

True! it indicates a baby’s chance of survival and health later in life.

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5
Q

What is a healthy birthweight?

A

2.5-4kgs

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6
Q

Jared was born at 1.8kg, where does this classify him in terms of his birthweight?

A

Low birth weight (<2.5kg)

Note: very low birth weight (<1.5kg)

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7
Q

What does APGAR stand for?

A
  • Appearance ie skin colour (0 = cyanotic, 1 = peripheral cyanosis, 2 = pink)
  • Pulse ie heart rate (0=0, 1 = < 100, 2 = 100-140)
  • Grimace: reflex irritability ie to a light pinch (0 = no response to stimulation, 1 = Grimace or weak cry when stimulation, 2 = cry when stimulated)
  • Activity (tone): (0: floppy, 1 = some flexion, 2 = well flexed and resisting extension)
  • Respiration: (0: apneic, 1 = slow, irregular breathing, 2 = strong cry)
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8
Q

What is the purpose of APGAR?
Minimum vs maximum score?
After birth how often is it checked?
What is the significance?

A
  • Determines the time taken for a newborn to adapt to normal physiological cycle
  • Minimum score = 0 & max = 10 (7+ is good = no need to monitor)
  • 0, 1, 5 & 10 mins and then continuously until 24hrs post birth
  • Note: no baby will have a score of 100% at birth
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9
Q

What is the significance of the APGAR?

A

Babies receive oxygenated blood through the placenta when in the womb. Once they are born, the babies lung then start participating in the oxygenation cycle.

The APGAR score is assessing the time needed to adapt to their normal physiological cycle of breathing + start taking active breaths

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10
Q

What milestone can we expect at 2-3 months?

A

Head in midline in supine/hold head upright when carried

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11
Q

What milestone can we expect at 3-4 months?

A

Rolling

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12
Q

What milestone can we expect at 6 months?

A

Sitting

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13
Q

What milestone can we expect at 7-9 months?

A

Crawling

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14
Q

What milestone can we expect at 8-10 months?

A

Pull to stand/standing with support

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15
Q

What milestone can we expect at 10-11 months

A

Cruising around furniture

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16
Q

What milestone can we expect at 11 months?

A

Standing without support

17
Q

What milestone can we expect at 12-18 months?

A

Independent walking

18
Q

What milestone can we expect at 18 months?

19
Q

What milestone can we expect at 24 months?

A

Walking up/down stairs

20
Q

Fine motor development - Milestones
- Birth
- 2 months?
- 3 months?
- 4 months?
- 5 months?

A
  • Birth: hand fisted, grasp reflex
  • 2 months: hands open, may retain a placed rattle briefly
  • 3 months: hands to mouth and midline
  • 4 months: 2 handed reach, can retain object in hand, shaking objects
  • 5 months: Bidextrous grasp - holds objects with 2 hands
21
Q

Fine motor development - Milestones
- 6 months
- 7 months
- 9 months
- 11 months

A
  • 6 months: transfer object between hands
  • 7 months: palmar grasp and thumb adducting, one handed reach
  • 9 months: pincer grisp (pellets), pointing with index finger
  • 11 months: takes object out of container, claps hands
22
Q

Motor development milestones:
- What is expected of a 12-24 month old toddler?
- What is expected of a pre-schooler: 3-5?

A

Toddler (12-24 month): lateral cruising –> pushing a walker, independent walking, basic GMS (kicking, scoop catch, jump, run, step up and step down with railing)

Pre-schooler (3-5 years) –> more complex GMS (single leg stance, hopping, catch, drop kick, jump rope, hopscotch, ride bike, ride scooter, ascend/descend stairs independently, faster running and agility).

23
Q

What are the milestones for personal social development?
- 2 months
- 3 months
- 6 months
- 9 months
- 1 year

A

2 months = social smile
3 months = recognises mother
6 months = smiles at mirror image, identifies familiar face/stranger
9 months = waves bye - bye, sociable/chatty (babbles)
1 year = plays simple ball games, feeds self with a spoon

24
Q

What is the Galant reflex? Primitive Spinal reflex

A

Stimulus: Infant is on their stomach & a downward stroke is applied
Response: Infant will twitch their hips towards the touch
Appearance: In utero: 20 weeks
Disappearance: 3-9 months

25
What is the crawl reflex? Primitive Spinal reflex
Stimulus: infant is placed on their stomach Response: pulls their legs under their body and kicks them out in a crawling motion Time of appearance: at birth Time of disappearance: by 12 weeks
26
What is the rooting reflex? Primitive Spinal reflex
Stimulus: stroke corner of their mouth Response: face turns towards the side Time of appearance: at birth Time of disappearance: By 12 weeks
27
What is the sucking reflex? Primitive Spinal reflex
Stimulus: introduce a finger into the mouth Response: sucking action of the lips and jaw Time of appearance: at birth Time of disappearance: 3-4 months
28
What is the moro (startle) reflex? Primitive Spinal reflex
Stimulus: supine and back of the head is supported. Drop the head backwards associated with a loud sound. Response: abduction and extension of arms followed by adduction of the arms (as in embrace). often accompanied by a cry Time of appearance: 9 weeks in utero, fully present at birth Time of disappearance: 3-4 months NOTE: if only one limb is ext/abd consider an issue with the limb eg hemiparesis (a normal response should be bilateral & symmetrical)
29
What is the babinski reflex? Primitive Spinal reflex
Stimulus: baby is in supine or sitting and a stroke is applied to the lateral aspect of foot from heel to the base of the great toe Response: Fanning of all 5 toes, extension of the hallux Time of appearance: at birth Time of disappearance: 1-2 years (stays until maturation/myelination of the nervous system has happened) If still fanning after 2 years = pathological ie neurological concern
30
What is the flexor withdrawal? Primitive Spinal reflex
Stimulus: noxious stimuli to the sole of the foot Response: uncontrolled flexion response of the stimulated leg Time of appearance: at birth Integration: 1-2 months
31
What is the Crossed extension reflex? Primitive Spinal reflex (stimulus & response)
Stimulus: noxious stimuli to ball of foot Response: opposite lower extremity adducts and extends and foot goes into PF
32
What is the stepping reflex? Primitive Spinal Reflex
Stimulus: support the infant by holding around their thorax and place their feet flat on a surface. Response: Alternating steps forward are observed Time of appearance: at birth Time of disappearance: 6 months
33
What is the grasp reflex? Primitive Spinal Reflex
Stimulus: press finger/suitable object into palm from ulnar side Response: fingers flex and grip the object Time of appearance: at birth Time of disappearance: By 12 weeks Note: a negative reflex is a good indicator of spasticity or prolonged reflex ie 3 mths + = something is wrong neurologically
34
What is the TLR reflex? Brainstem/Tonic reflex
Tonic Labrinthine Reflex (commonly present with galant reflex) Stimulus: changes of orientation of the head in space Response: prone position = flexion of all limbs as they try to lift their head. Supine position = extension of all limbs as the head is moved backward. Time of appearance: Birth Time of disappearance: 2-4 months
35
What is the ATNR reflex? Brainstem/Tonic reflex
Asymmetrical Tonic Neck Reflex Stimulus: supine position - head in mid position, arms and legs extended (fencing reflex). Attract infants attention to turn head and look across one shoulder. Response: increase in "extensor tone" on face side and increase in "flexor tone" on skull side. Time of appearance: at birth Time of disappearance: 6 months Rolling is going to be impaired because the reflexive response will cause their arm to go into extension
36
What is symmetrical tonic neck reflex? Brainstem/Tonic reflex
Stimulus: baby is in supine with head in mid position (arms and legs extended). Flexion or extension of the head. Response: flexion of head: arms flex legs extend. Extension of head: arms extend, legs flex. Time of appearance: emerges after ATNR phases out (6-9 months) Time of disappearance: 9-11 months This is a reflex which basically prepares the baby for walking

Outpatient (Cerebral Palsy) (4 decks)

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