Movement Flashcards
Developmental Coordination Disorder (DCD)
learning-based motor disability; marked by a significant delay in the acquisition of age-appropriate, motor-based skills; non-progressive
DCD critical feature for diagnosis:
child must demonstrate a marked impairment in the development of motor coordination that significantly interferes with academic achievement or ADLs.
physician must rule out other conditions
Spinal muscular atrophy (SMA)
presents clinically with progressive muscle weakness, muscle atrophy; differentiated from MD by site of pathology and genetics
SMA Causes
genetically inherited degenerative disorders of the anterior horn cell of the spinal cord and motor cells of the cranial nuclei
inheritance pattern is autosomal recessive (male and female children affected equally; defective gene must be passed down by both parents)
Type I SMA
(acute infantile SMA or Werdnig-Hoffmann disease)
most rapidly progressive
onset prior to 6 months of age (can occur in utero)
marked hypotonia, unable to achieve independent sitting
Feeding and respiration are significantly affected
typically do not live beyond 2-3 years old death results from respiratory infection and/or compromise
Type II SMA
(chronic or intermediate SMA)
onset occurs in later infancy or early childhood
less severe symptoms
children are able to learn to sit/stand independently and may become ambulatory
no feeding difficulties
variable progression (may be periods of stability without further progression)
many survive until adulthood
Goals of intervention: prevention of contractures, maintenance of postural alignment
Type III SMA
(Kugelberg-Welander syndrome)
least progressive
onset between 5-15 years old
independent ambulation maintained well into adulthood, despite progressive muscle strength in BLE
variable progression
resembles DMD
Children and adolescents have difficulty ambulating, climbing stairs, rising from the floor
Muscular Dystrophy (MD)
presents clinically with progressive muscle weakness, muscle atrophy; differentiated from SMA by site of pathology and genetics; umbrella term for disorders in which there is a primary myopathy that results from the destruction of muscle fibers
MD classifications
Duchenne MD (DMD) is most common Becker MD Emery-Dreifuss MD Congenital MDs Facioscapulohumeral MD Limb-girdle dystrophies
DMD symptoms
degenerative process affects smooth muscle of organs (e.g., heart, intestines) → eventually leads to premature death
Mild intellectual impairment in areas of verbal reasoning and verbal processing
Motor difficulties typically observed in preschool/early school years (e.g., frequent falling, waddling or -Trendelenburg gait, difficulty climbing stairs and rising from the floor (Gowers’ sign) most symptoms result from weak pelvic musculature
Lumbar lordosis becomes apparent over time as hip extensor muscles begin to weaken
Typical presentation: diminished deep tendon reflexes and generalized, symmetric muscle atrophy
Gastrocnemius muscles often become hypertrophied due to the infiltration of fat and connective tissue into the muscle
hypertrophy may lead to increased flexion of the knee and contractures of hamstrings
Contractures may occur in ankles and elbows By 7-10 years old, typically lose ability to ambulate and become w/c dependent
predisposes kids to scoliosis and foot deformities
Spina bifida cystica
a protrusion of the spinal cord and meninges through a defect in the vertebral arch occurs
Cycle of normative motor development
Selective voluntary movement/strength Skill Development of normal tone Alignment, stability, symmetry, midline, dissociation of body parts, normal postural mechanism. Again
Characteristics of normal tone
Effective co-contraction in proximal joints (stability)
Able to maintain position of limb that is passively moved
Balanced tone between agonist and antagonist muscles
Shift from stability to mobility
Muscle groups used selectively or in groups
Damping
the little shaking or oscillation of movement. Can’t grade movement. Often when tired.
Stiffness
Ability to isometrically hold a position
Disassociation
Non-mirrored movement, use limb independently.
Active firing
The amount of tension that is generated in our muscles as we prepare to move
Types of abnormal muscle tone
Hypertonicty (Spasticity and rigidity)
Hypotonicity (flaccidity)
Tone
Muscles in constant, involuntary contraction
Control
Conscious decision
The normal central postural control mechanism
produces postural control that provides an appropriate level of stability and mobility. –Ability to stand in midline and orientation in space.
Components of control
integration of reflexes, righting reactions, voluntary movement
Cycle of normal development
Normal tone, alignment/symmetry, posture, voluntary movement, skill
Weight bearing is closed or open system?
Closed system
Cycle of abnormal development
Abnormal tone, asymmetry, poor posture, minimal voluntary movement, poor motor skills
Blocks
Neck hyperextension Head and neck asymmetry Scapular adduction—Don’t use upper extremity properly. Impacts coming to midline Scapulo-humeral tightness Thoracic kyphosis-- Anterior pelvic tilt Posterior pelvic tilt
Conditions that affect motor development
CP, Spina bifida, MD, spinal muscular atrophy, DCD
CP types
Spastic
Dyskinetic
Ataxic
Spastic CP traits
Hypertonia
Hyperreflexia
Diskinetic CP traits
Athetosis/chorea/dystonia
Usually hypotonic
Ataxic CP traits
Hypotonic
uncoordinated and irregular movements
Abnormal tone
Spasticity Athetosis Ataxia Flaccidity Mixed
Distribution CP
Paraplegic Quadriplegic Hemiplegic Triplegic Monoplegic Diplegia
Secondary CP impairments
Contractures Unsteady gait Visual processing d/o Bowel/bladder control Breathing difficulty Skin integrity
Common reflexes CP
Neck–ATNR, STNR
Labyrienthine–TLR, Supine/prone
Associated–Associated tone
