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PTA - Neuro Peds > Neuro Peds - 01 - Normal Growth and Development > Flashcards

Neuro Peds - 01 - Normal Growth and Development Flashcards

1
Q

what is Integration?

A

Integration is the mechanism by which less mature responses are incorporated into voluntary movement.

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2
Q 
list the pre-natal reflexes developed at the following milestones:
7 weeks
10 1/2 weeks
14 weeks
22 weeks
29-30 weeks
Birth
A

7 weeks - w/d head if stimulus at lips (pull away)
10 1/2 weeks - swallow
14 weeks - moves body if stimulus to head
22 weeks - pout
29-30 weeks - thumb suck
Birth - bladder

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3
Q

Newborns have what two types of movement?

A

reflexive

spontaneous

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4
Q

what is development?

A

the process of change in motor behavior that is related to the age of the individual

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5
Q

what influences development?

A

nutrition
stimulation
genetics
environment/socialization

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6
Q

name the important Primitive Reflexes

A 
Flexor Withdrawal
Crossed Extensor
Galant
Placing
Stepping
Plantar
Palmar Grasp
Moro
Rooting
Traction
ATNR
STNR
TLR
Landau
Positive Support
Suck-swallow
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7
Q

describe the Role of Righting Reactions

A

responsible for

  • orienting the head in space and keeping the eyes and mouth horizontal
  • returning to midline
  • seeing the world straight
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8
Q

list the order of Head Righting Reactions

A

Neck (immature) - 34 wks gest
Labyrinthine - 0-2 mos
Optical - 0-2 mos
Neck (mature) 4-6 mos

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9
Q

list the order of Trunk Righting Reactions

A

Body (immature) - 34 wks gest
Body (mature) - 4-6 mos
Landau - 3-4 mos

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10
Q

list the order Protective Reactions

A 
Downward LE	- 4 months
Forward UE	- 6 months
Sideways UE	- 7 months
Backward UE	- 9 months
Stepping LE	- 15 months
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11
Q

describe role of Protective Reactions in normal development

A

movements that occur in response to rapid displacement

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12
Q

list order of Equilibrium Reactions

A 
Prone (6 months)
Supine (7-8 months)
Sitting (7-8 months)
Quadruped (9-12 months)
Standing (12-24 months)
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13
Q

what is role of Equilibrium Reactions?

A

allow the body to adapt to slow changes in relationship between COM and BOS

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14
Q

what is the Order of development of the Reactions?

A

Righting
Support
Protective
Equilibrium

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15
Q

describe the 4 phases of early walking

A

1st: wide stance and high arm guard
2nd: feet come more under pelvis and mid-arm guard
3rd: feet closer in and low arm guard
4th: heel to toe gait and no arm guard

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16
Q

describe the Flexor Withdrawal Reflex

A

position: supine
test: noxious stimulus to sole of one foot
response: withdrawal of stimulated LE from stimulus

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17
Q

what is the normal duration for the Flexor Withdrawal Reflex?

A

birth to 2 months

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18
Q

what is the function of the Flexor Withdrawal reflex?

A

protection

pain/injury avoidance

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19
Q

what is the problem if Flexor Withdrawal is persistent?

A

if Flexor Withdrawal is stronger than Positive Support, standing is not possible

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20
Q

describe the Crossed Extension Reflex

A

position: supine
test: hold one LE at the knee in extension; noxious stimulus to sole of the foot
response: flexion, adduction and then extension of contralateral LE

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21
Q

what is the normal duration of the Crossed Extensor Reflex?

A

birth to 2 months

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22
Q

what is the function of the Crossed Extensor Reflex?

A

Helps maintain balance, pushes body away from painful stimulus and stiffens contralateral leg to support entire weight of the body

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23
Q

what is the problem if the Crossed Extensor Reflex persists?

A
  • Difficulty flexing both legs at once (bridging)

- If obligatory, the reflex will dominate posture and inhibit reciprocal kicking and walking

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24
Q

describe the Positive Support Reflex

A

position: supported in vertical
test: allow firm contact of child’s feet with floor or table
response: bilateral LEs extend with contraction of flexors and extensors into weight bearing

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25
Q

what is the normal duration of the Positive Support Reflex?

A

birth to 2 months

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26
Q

what is the function of the Positive Support Reflex?

A

it is prerequisite for stepping reflex

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27
Q

what is the problem if Positive Support Reflex persists?

A

difficulty bridging

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28
Q

describe the Plantar reflex

A

position: supine
test: stroke lateral aspect of the sole of the child’s foot from the heel towards the toes.
response: toe extension

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29
Q

what is the normal duration of the Plantar reflex?

A

birth to 9 months

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30
Q

what is the function of the Plantar reflex?

A

Prepare for Positive Support reflex

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31
Q

what is the problem if the Plantar reflex persists?

A

a sign of under developed neural something?

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32
Q

describe the Moro reflex

A

position: supine
test: quickly tip child backwards to allow a 30 degree head drop
repsonse: child should startle by quickly extending, abducting shoulders, extending and abducting fingers, crying. in 2-3 seconds, shoulders flex and adduct to bring UE back to chest

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33
Q

what is the normal duration of the Moro reflex?

A

birth to 6 months

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34
Q

what is the function of the Moro reflex?

A

alarm reflex

help child cling to mother

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35
Q

what is the problem if Moro Reflex persists?

A

over-sensitivity to sensory stimuli

36
Q

describe the Asymmetrical Tonic Neck Reflex

A

postion: supine
test: turn child’s head slowly to one side and hold gently
repsonse: arm and leg extend on face side, arm and leg flex on skull side

37
Q

what is the normal duration of the Asymmetrical Tonic Neck Reflex?

A

birth to 6 months

38
Q

what is the function of the Asymmetrical Tonic Neck Reflex?

A

Connection between touch and vision helps to establish distance perception and hand-eye coordination. In the early months, ATNR locks vision on to anything which catches attention.

39
Q

what is the problem if Asymmetrical Tonic Neck Reflex persists?

A

cannot roll
cannot bring extended arm to mouth
hip dislocation on flexed side
affect trunk and predispose to scoliosis

40
Q

describe the Symmetrical Tonic Neck Reflex

A

position: supine over examiner’s knees or quadruped
test: passive or active neck extension and flexion
response: neck extension produces UE extension and LE flexion, neck flexion causes UE flexion and LE extension

41
Q

what is the normal duration of the Symmetrical Tonic Neck Reflex?

A

4 to 12 months

42
Q

what is the function of the Symmetrical Tonic Neck Reflex?

A

is a stepping stone to crawling on hands and knees (creeping)

43
Q

what is the problem if Symmetrical Tonic Neck Reflex persists?

A

prevents reciprocal creeping, allowing child only to bunny hop
when obligatory, arms and legs imitate or contradict the head movement

44
Q

describe the Tonic Labyrinthine Reflex

A

position: supine, prone
test: passively attempt to lift child’s head from surface
response: supine - extensor tone dominates in body; prone - flexor tone dominates in body
* Landau Reflex (vertical suspension)

45
Q

what is the normal duration of the Tonic Labyrinthine Reflex?

A

birth to 6 months

46
Q

what is the function of the Tonic Labyrinthine Reflex?

A

to produce change in muscle tone and posture
increase extensor tone
increase flexor tone

47
Q

what is the problem if the Tonic Labyrinthine Reflex persists?

A

can impair infant’s ability to develop antigravity motion
cannot flex against gravity in supine
cannot extend against gravity in prone

48
Q

what is the role of Righting Reactions in normal motor development?

A

righting reactions are the first in the sequence of development of postural reactions

  • For balance
  • Orienting head and eyes in space
  • To get back to midline
  • To see the world straight
49
Q

what is the progression of the Righting Reactions?

A

1st - Head righting

  • Optical: visual clues (birth—-to persist)
  • Labyrinthine: gravity clues (birth—-to persist)

2nd - Trunk righting

  • Neck on body: head turn causes body to turn
  • Body on body: upper or lower trunk turn causes body to turn
50
Q

what are the Support Reactions?

A

Kind of like progression to like the Positive Supporting Reflex.
But without stimulus.

51
Q

What are Protective Reactions?

What is their role?

A

Extremity movements in response to rapid movement

To safeguard balance in higher postures, such as sitting.

52
Q

what is the order of onset of Protective Reactions?

A 
Downward LE	4 months
Forward UE	6 months
Sideways UE	7 months
Backward UE	9 months
Stepping LE	15 months
53
Q

what is the purpose of the Equilibrium Reactions?

A
  • Allow the body to adapt to slow changes in relationship between COM and BOS
  • Incorporate righting reactions
  • Try to keep COM inside BOS
54
Q

what is the order of onset of the Equilibrium Reactions?

A 
Prone (6 months) (5)
Supine (7-8 months) (8)
Sitting (7-8 months) (8)
Quadruped (9-12 months) (12)
Standing (12-24 months) (15)
55
Q

gross and fine motor milestones:

birth to 3 months

A

gross:

  • prone - all flexy, by 3 mos some extend, weight-bearing arms
  • supine - head not midline
  • pull to sit - head lag
  • rolling - only a reflex

fine:
- palmar grasp reflex

56
Q

gross and fine motor milestones:

4 months

A

gross:

  • prone - lift head to 90 degree
  • supine - midline orientation, head and hands
  • pull to sit - keep head in line
  • rolling - still reflex

fine:
__

57
Q

gross and fine motor milestones:

5 months

A

gross:

  • prone - swimming, prop elbows, small weight shifts
  • supine - neck flexion, leg pedaling, bottom lifting
  • pull to sit - chin tuck, counter balance with legs
  • rolling - still accidental
  • sitting - propped, fall over

fine:

  • raking
  • transfer object from one hand to other
58
Q

gross and fine motor milestones:

6 months

A

gross:

  • prone - pivot, lots of swimming
  • supine - eh
  • pull to sit - right up to stand
  • sitting - pillows for low back, one hand play/one hand support
  • rolling - voluntary
fine:
- reaching
- grasping
- letting go
(voluntary palmar grasp)
59
Q

gross and fine motor milestones:

7 months

A

gross:

  • prone - prop straight arms
  • supine - mostly avoided
  • quadruped - maybe
  • sitting - ring sit, half long

fine:
- radial palmar grasp

60
Q

gross and fine motor milestones:

8 months

A

gross:

  • prone - crawling, quadruped rocking
  • sitting - trunk twist
  • more transitions

fine:
__

61
Q

gross and fine motor milestones:

9 months

A

gross:

  • prone - creeping, quad rocking, quad reaching
  • sitting - side, transition to prone or quad
  • kneeling - pull to half
  • standing - against surface, upright, weight-shifting, dissociated arm/leg
  • cruising

fine:

  • radial digital grasp
  • inferior pincer grasp
62
Q

gross and fine motor milestones:

12 months

A

gross:
- walking - wide-stance/high-guard, narrower-stance/mid-guard, more narrow-stance/low-guard, heel-toe/no-guard

fine:
superior pincer grasp
three-jaw chuck

63
Q

what is motor control?

A

the ability to maintain posture and perform movement

64
Q

how does motor control normally develop?

A

mobility
stability
controlled mobility
skill

65
Q

identify the three phases of motor learning

A

cognitive - understand what to do

associative - learn how to do (practice)

autonomous - get really good and don’t have to think about it

66
Q

gross motor milestones 16-18 months

A
  • stairs
  • walk sideways/backwards
  • floor to stand
  • jumping
  • squat
67
Q

gross motor milestones 18 months gait

A
  • Reciprocal arm swing
  • “running-like” walk - no flight phase
  • Momentary SLS - just a tiny movement, getting ready for stairs
  • Decrease in falls
68
Q

gross motor milestones 2 yo

A
  • Gait
  • Stairs
  • Jumping - flight phase
  • SLS = 1-3s - can do stairs, kick a ball, step over obstacle
  • Kick a ball
  • Throw a ball
  • Stepping over obstacles
  • True running - stopping and turning are hard, no agility
69
Q

gross motor milestones 3 yo

A
  • Gait - more typical, heel strike, pelvic rotation developing, longer step length
  • Pedaling a tricycle -
  • Climbing
  • Agility emerges
  • Tandem stance
  • SLS = 3s
  • Stairs - reciprocally up and down (unless really tiny)
  • Jumping - over obstacle, with lead foot
70
Q

gross motor milestones 4 yo

A
  • SLS = 4-6s
  • Hop 4-6x
  • Hopping forward - swing air leg
  • Galloping
  • Catch a small ball
  • Throw ball
71
Q

gross motor milestones 5 yo

A
  • SLS = 8-10 seconds
  • Walk forward on balance beam
  • Hop 8-10x
  • skipping (diff than gallop)
  • 2-3ft standing broad jump
  • Skip
  • Kick a rolling ball
  • Catch a ball
72
Q

gross motor milestones 6 yo

A
  • SLS = 10s + with eyes opened/closed
  • Throw/catch small ball
  • Walk on balance beam
  • Ride bike
  • Skate
  • Striking
73
Q

What is the progression of rising from supine to standing?

A 
1 - supine
2 - rolling
3 - four-point position (quadruped)
4 - plantigrade (bent at hips, hands on floor)
5 - squat
6 - semi-squat
7 - stand
74
Q

before PT with children with low tone:

A

ramp them up

75
Q

before PT children with high tone:

A

calm them down

76
Q

how to ramp up a low tone muscle:

A

vestibular - swinging, rocking, spinning
touch - brush
sound - music
vision - bright lights

77
Q

how to calm down high tone muscle:

A

touch - big hug, wrap up in mat, deep pressure, body sock

approximation - press down and rock (as in quadruped)

78
Q

why is the Use of Sensory Input important?

A

to wake up muscles in Low Tone kids

to calm down muscles in High Tone kids

79
Q

What are the details on using Touch to ramp up low tone?

A
  • child should do himself if possible
  • firm pressure (so as not to tickle)
  • proximal->distal : start at arms/legs, move centrally as needed, face last (if at all)
  • do in a closed environment
  • only for a few minutes
80
Q

what are the details on using Touch to calm down high tone?

A
  • use deep pressure - as in bear hug or body sock or wrap in a mat
81
Q

what are details on using Approximation to calm down high tone:

A

weighting and un-weighting of joints in weight bearing positions

  • quadruped rocking
  • bounce on therapy ball
82
Q

what are the details for using Vision to ramp up low tone?

A
  • ask all the pertinent seizure questions

- note that babies will only see contrast

83
Q

what is a detail for using Hearing/Sound to ramp up or calm down?

A
  • use the right tone of voice to avoid a certain reflex

fainting goats

84
Q

what are the Developmental Principles?

A
  • cephalocaudal
  • proximodistal
  • reflexive to voluntary
  • general to specific
85
Q

what are three theories of motor development?

A

Neural-Maturational - all on the nervous system
Cognitive - how individual perceives and interacts with environment
Dynamic Systems - everything has a role in development

86
Q

When is Early Intervention?

A

0-3 months

87
Q

What is the importance of family and environment when treating?

A
  • family centered care - involve parents/siblings/caregivers to also “treat”
  • do in natural environment (better than clinic)

PTA - Neuro Peds (14 decks)

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