Neuro Peds - 01 - Normal Growth and Development Flashcards
what is Integration?
Integration is the mechanism by which less mature responses are incorporated into voluntary movement.
list the pre-natal reflexes developed at the following milestones: 7 weeks 10 1/2 weeks 14 weeks 22 weeks 29-30 weeks Birth
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
Newborns have what two types of movement?
reflexive
spontaneous
what is development?
the process of change in motor behavior that is related to the age of the individual
what influences development?
nutrition
stimulation
genetics
environment/socialization
name the important Primitive Reflexes
Flexor Withdrawal Crossed Extensor Galant Placing Stepping Plantar Palmar Grasp Moro Rooting Traction ATNR STNR TLR Landau Positive Support Suck-swallow
describe the Role of Righting Reactions
responsible for
- orienting the head in space and keeping the eyes and mouth horizontal
- returning to midline
- seeing the world straight
list the order of Head Righting Reactions
Neck (immature) - 34 wks gest
Labyrinthine - 0-2 mos
Optical - 0-2 mos
Neck (mature) 4-6 mos
list the order of Trunk Righting Reactions
Body (immature) - 34 wks gest
Body (mature) - 4-6 mos
Landau - 3-4 mos
list the order Protective Reactions
Downward LE - 4 months Forward UE - 6 months Sideways UE - 7 months Backward UE - 9 months Stepping LE - 15 months
describe role of Protective Reactions in normal development
movements that occur in response to rapid displacement
list order of Equilibrium Reactions
Prone (6 months) Supine (7-8 months) Sitting (7-8 months) Quadruped (9-12 months) Standing (12-24 months)
what is role of Equilibrium Reactions?
allow the body to adapt to slow changes in relationship between COM and BOS
what is the Order of development of the Reactions?
Righting
Support
Protective
Equilibrium
describe the 4 phases of early walking
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
describe the Flexor Withdrawal Reflex
position: supine
test: noxious stimulus to sole of one foot
response: withdrawal of stimulated LE from stimulus
what is the normal duration for the Flexor Withdrawal Reflex?
birth to 2 months
what is the function of the Flexor Withdrawal reflex?
protection
pain/injury avoidance
what is the problem if Flexor Withdrawal is persistent?
if Flexor Withdrawal is stronger than Positive Support, standing is not possible
describe the Crossed Extension Reflex
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
what is the normal duration of the Crossed Extensor Reflex?
birth to 2 months
what is the function of the Crossed Extensor Reflex?
Helps maintain balance, pushes body away from painful stimulus and stiffens contralateral leg to support entire weight of the body
what is the problem if the Crossed Extensor Reflex persists?
- Difficulty flexing both legs at once (bridging)
- If obligatory, the reflex will dominate posture and inhibit reciprocal kicking and walking
describe the Positive Support Reflex
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
what is the normal duration of the Positive Support Reflex?
birth to 2 months
what is the function of the Positive Support Reflex?
it is prerequisite for stepping reflex
what is the problem if Positive Support Reflex persists?
difficulty bridging
describe the Plantar reflex
position: supine
test: stroke lateral aspect of the sole of the child’s foot from the heel towards the toes.
response: toe extension
what is the normal duration of the Plantar reflex?
birth to 9 months
what is the function of the Plantar reflex?
Prepare for Positive Support reflex
what is the problem if the Plantar reflex persists?
a sign of under developed neural something?
describe the Moro reflex
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
what is the normal duration of the Moro reflex?
birth to 6 months
what is the function of the Moro reflex?
alarm reflex
help child cling to mother
what is the problem if Moro Reflex persists?
over-sensitivity to sensory stimuli
describe the Asymmetrical Tonic Neck Reflex
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
what is the normal duration of the Asymmetrical Tonic Neck Reflex?
birth to 6 months
what is the function of the Asymmetrical Tonic Neck Reflex?
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.
what is the problem if Asymmetrical Tonic Neck Reflex persists?
cannot roll
cannot bring extended arm to mouth
hip dislocation on flexed side
affect trunk and predispose to scoliosis
describe the Symmetrical Tonic Neck Reflex
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
what is the normal duration of the Symmetrical Tonic Neck Reflex?
4 to 12 months
what is the function of the Symmetrical Tonic Neck Reflex?
is a stepping stone to crawling on hands and knees (creeping)
what is the problem if Symmetrical Tonic Neck Reflex persists?
prevents reciprocal creeping, allowing child only to bunny hop
when obligatory, arms and legs imitate or contradict the head movement
describe the Tonic Labyrinthine Reflex
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)
what is the normal duration of the Tonic Labyrinthine Reflex?
birth to 6 months
what is the function of the Tonic Labyrinthine Reflex?
to produce change in muscle tone and posture
increase extensor tone
increase flexor tone
what is the problem if the Tonic Labyrinthine Reflex persists?
can impair infant’s ability to develop antigravity motion
cannot flex against gravity in supine
cannot extend against gravity in prone
what is the role of Righting Reactions in normal motor development?
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
what is the progression of the Righting Reactions?
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
what are the Support Reactions?
Kind of like progression to like the Positive Supporting Reflex.
But without stimulus.
What are Protective Reactions?
What is their role?
Extremity movements in response to rapid movement
To safeguard balance in higher postures, such as sitting.
what is the order of onset of Protective Reactions?
Downward LE 4 months Forward UE 6 months Sideways UE 7 months Backward UE 9 months Stepping LE 15 months
what is the purpose of the Equilibrium Reactions?
- Allow the body to adapt to slow changes in relationship between COM and BOS
- Incorporate righting reactions
- Try to keep COM inside BOS
what is the order of onset of the Equilibrium Reactions?
Prone (6 months) (5) Supine (7-8 months) (8) Sitting (7-8 months) (8) Quadruped (9-12 months) (12) Standing (12-24 months) (15)
gross and fine motor milestones:
birth to 3 months
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
gross and fine motor milestones:
4 months
gross:
- prone - lift head to 90 degree
- supine - midline orientation, head and hands
- pull to sit - keep head in line
- rolling - still reflex
fine:
__
gross and fine motor milestones:
5 months
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
gross and fine motor milestones:
6 months
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)
gross and fine motor milestones:
7 months
gross:
- prone - prop straight arms
- supine - mostly avoided
- quadruped - maybe
- sitting - ring sit, half long
fine:
- radial palmar grasp
gross and fine motor milestones:
8 months
gross:
- prone - crawling, quadruped rocking
- sitting - trunk twist
- more transitions
fine:
__
gross and fine motor milestones:
9 months
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
gross and fine motor milestones:
12 months
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
what is motor control?
the ability to maintain posture and perform movement
how does motor control normally develop?
mobility
stability
controlled mobility
skill
identify the three phases of motor learning
cognitive - understand what to do
associative - learn how to do (practice)
autonomous - get really good and don’t have to think about it
gross motor milestones 16-18 months
- stairs
- walk sideways/backwards
- floor to stand
- jumping
- squat
gross motor milestones 18 months gait
- Reciprocal arm swing
- “running-like” walk - no flight phase
- Momentary SLS - just a tiny movement, getting ready for stairs
- Decrease in falls
gross motor milestones 2 yo
- 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
gross motor milestones 3 yo
- 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
gross motor milestones 4 yo
- SLS = 4-6s
- Hop 4-6x
- Hopping forward - swing air leg
- Galloping
- Catch a small ball
- Throw ball
gross motor milestones 5 yo
- 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
gross motor milestones 6 yo
- SLS = 10s + with eyes opened/closed
- Throw/catch small ball
- Walk on balance beam
- Ride bike
- Skate
- Striking
What is the progression of rising from supine to standing?
1 - supine 2 - rolling 3 - four-point position (quadruped) 4 - plantigrade (bent at hips, hands on floor) 5 - squat 6 - semi-squat 7 - stand
before PT with children with low tone:
ramp them up
before PT children with high tone:
calm them down
how to ramp up a low tone muscle:
vestibular - swinging, rocking, spinning
touch - brush
sound - music
vision - bright lights
how to calm down high tone muscle:
touch - big hug, wrap up in mat, deep pressure, body sock
approximation - press down and rock (as in quadruped)
why is the Use of Sensory Input important?
to wake up muscles in Low Tone kids
to calm down muscles in High Tone kids
What are the details on using Touch to ramp up low tone?
- 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
what are the details on using Touch to calm down high tone?
- use deep pressure - as in bear hug or body sock or wrap in a mat
what are details on using Approximation to calm down high tone:
weighting and un-weighting of joints in weight bearing positions
- quadruped rocking
- bounce on therapy ball
what are the details for using Vision to ramp up low tone?
- ask all the pertinent seizure questions
- note that babies will only see contrast
what is a detail for using Hearing/Sound to ramp up or calm down?
- use the right tone of voice to avoid a certain reflex
fainting goats
what are the Developmental Principles?
- cephalocaudal
- proximodistal
- reflexive to voluntary
- general to specific
what are three theories of motor development?
Neural-Maturational - all on the nervous system
Cognitive - how individual perceives and interacts with environment
Dynamic Systems - everything has a role in development
When is Early Intervention?
0-3 months
What is the importance of family and environment when treating?
- family centered care - involve parents/siblings/caregivers to also “treat”
- do in natural environment (better than clinic)
