Normal Motor Development Flashcards
What are the theories of motor development?
Neuromaturational theory, dynamic systems theory, neuronal group selection theory
What is a central pattern generator?
CPG; neural networks that can produce rhythmic patterned outputs without rhythmic sensory or central input. (Underlie walking, chewing, infantile kicking, etc)
Primary tenets of the neuromaturational theory
Unfolding of predetermined patterns, supported but not fundamentally altered by the environment.
Progressive hierarchical changes in the CNS
Movement initially reflexive in nature
Cephalocaudal and proximal to distal development
Development must progress through a specific set sequence
Pediatric physical therapy initially developed according to which model?
Neuromaturational
What are primitive reflexes?
Brainstem mediated, complex, automatic movement patterns some of which are present from 28 weeks gestation, with CNS maturation they are harder and harder to elicit when voluntary motor activity and cortical inhibition emerge and take over.
Stereotypical patterns, elicited by specific sensory stimuli.
What theory is the basis for current pediatric physical therapy?
Dynamic Systems Theory
Basic tenets of dynamic systems theory
Cooperation among many subsystems within task specific context
Each system develops at own rate and is constrained or supported by physical and environmental factors.
Assess the subsystems, the environment and the task.
Series of states of stability, instability followed by reorg, and transition to new patterns of movement
Basic tenets of neuronal group selection theory
brain dynamically organized into variable networks the structure and function of which are selected by development and behavior.
Functional units are neuronal groups: collections of strongly interconnected neurons.
Afferent information produced by behavior and experience modifies the strength of the synaptic contacts allowing for situation specific selection.
3 requirements for neuronal group selection
basic repertoire of movement
availability of sensory information to identify and select adaptive forms of movement
means to strengthen the preferred movement response.s
What is a central pattern generator?
neural networks that produce rhythmic patterned outputs without rhythmic sensory or central input. (walking chewing infantile kicking)
Who had the behavioral perspective?
Skinner
What is the behavioral perspective?
the individual is reactive and is subject to influence by external stimulation. Environment is key in that persons behavior.
consequences of behavior determine its fate - positive and negative reinforcement
Who had the theory of cognitive development?
Piaget
What is the theory of cognitive development?
emphasizes an interaction between maturation of cognitive-neural structures and environmental opportunities to promote action. 4 stages
What are the 4 stages of the theory of cognitive development?
Sensorimotor
Pre-operational
Period of concrete operations
Formal operations
What was the impact of the Piagetian theory on pediatric physical therapy?
Primarily the inclusion of problem solving activities in therapeutic programs to assist in the cognitive-motivational aspect of facilitating motor development
What is the sensorimotor stage
birth-2 yr: child learns through sensory and motor experiences, discoveries by trial and error, repetition of activities is important at this stage.
What is the pre-operational stage
2-6 years: child begins to use symbols, development of language. Things seem very real.
What is the period of concreete operations stage
7-11 years: develops ability to classify objects according to characteristics - child can solve concrete problems in the here and now
What is the formal operations stage
2 yr- adult: able to deal with hypothetical and real situations, can think in abstract terms and consider possibilities, don’t have to see things to solve problems. Can think about possibilities/consequences.
What are the areas of development that assessments try to evaluate?
social/emotional, language/communication, cognitive, motor
Neonate motor development
physiological flexion, turn head side to side, muscle control in sagittal plane –> then frontal, extensors develop first. Obligatory nose/diaphragm breathers, phonation begins with birth cry. Child will react/startle to loud noises.
What is the neonate breathing rate?
40-60 breaths per minute
One month motor development
reduced physiologic flexion, pelvis may be down/flat, hands tend to be fisted
Two month motor development
Appears disorganized d/t dec. phys flex and inc. ext which isn’t balanced with antigravity control of flexion. Extension not balanced yet with flexion.
ATNR strong, astasia/abasia, labyrinthe righting, optical righting, cooing, moro reflex
Primary stepping and automatic walking reflexes gone.
What are astasia and abasia?
motor incoordination for standing/walking
Three month motor development
beginning of symmetry and midline orientation, hands to mouth/midline, prop on forearms in prone, rolls to side, beginning to weight shift, hands unfisted 50% of time
What is an indicator of motor problems at three months?
Inability to hold the head in midline or persistence of strong asymmetry.
What is the respiratory rate of a 3 mo old?
Decreases to 30-50 breaths per minute between 3-6 months
Month four is the month of ______
strong symmetry
Four month motor development
Strong symmetry, pull to sit, increased head control, landau, pivot prone, side-lying, rolls PRONE to supine, hands open more, expansion of cooing, contrasts in vocal play, localize source of sound
Five month motor development
emergence of lateral weight shifting on UE in prone, antigravity flexion and extension continue to improve, feet to mouth, propped sitting, begins to respond to name
Six month motor development
good head control (hallmark), sitting (w/ wide BOS), protective extension forward, rib cage pulled down with upright sitting, trunk rotation begins to develop, transfers objects hand to hand, brings things to mouth, rolling SUPINE to prone (body righting on body, ATNR inhibited for segmental rolling), babbling begins, likes to look in mirror, recognize is someone is a stranger, should be motivated to get something out of their reach. Should be concerned if not rolling at all. Supplementing solid foods.
What is required to roll SUPINE TO PRONE
body righting on body, ATNR inhibited for segmental rolling
Seven month motor development
prone is preferred position, may begin to belly crawl, STNR
Eight month motor development
Creeping is primary mode of locomotion, prefers sitting, pull to stand through kneeling or by using UE, cruising sideways, unable to sit to stand, Once up can’t figure out sitting back down, move from quadruped to sitting, may begin to climb, equilibrium reactions present in sitting, protective extension sideways.
Nine month motor development
good trunk control, may move through half kneel to standing, cruising around furniture, bang 2 cubes together, mama/dada non-specific, should have great sitting balance, hold a toy, pass it around reach out and grab other things all maintaining sitting, start to imitate others in simple play, add more substance to foods.
What are some warning signs at nine months?
don’t respond to own name or to stimulus from talking parents. Not following when you point. Not solid with sitting. No WB in LE.
10 month motor development
lower self from standing, increased LE control, stand with 1 HHA, walks with 2 HHA, mama/dada specific, learn to wave bye bye
11 month motor development
use LE to rise to standing maybe from squat position, able to stand alone briefly, about the time they will say another word.
12 month motor development
walking, fine pincer grip, scribbles after demonstration, follows one step command with gestures, has acquired 1-2 words other than mama/dada or names of other family, start to use a cup
What are some concerns at 12 months?
Not crawling with forward movement, or if they seem to be losing skills.
15 month motor development
stoops to pick up toy, walks carrying a toy, steady on feet, build 3-4 tower cube, uses spoon, points to one body part, start to help getting undresses, uses 3-5 words
18 month motor development
walk upstairs with 1 HHA, creeps down stairs on hands and knees backwards, throws ball, removes garmet, minimum 20 word vocabulary, at least 6 words beyond mom, dad, etc., simple pretend play
Other movements you may see
W sit, hitching, bunny hopping, bear standing.
2 y.o. important milestones
2-4 word sentences, follows simple instructions, kicks a ball, up/down stairs holding on, walks backwards, fairly steady with gait, jumps from 12 in step (one foot - more of a step down)
3 y.o. important milestones
up/down stairs alternating steps, pedals tricycle, 4-5 word sentences, can be mostly understood by strangers, can take turns, toilet training (2-3)
4 y.o. important milestones
up/down stairs without support, uses scissors, 5-6 word sentences, knows some colors, draws a person with 2-3 body parts, able to dress/undress may need some assistance
5 y.o. important milestones
able to hop, do a somersault, some skip, count 10 or more objects, knows name and address, established hand dominance
Weight in the first year
triples birth weight, then gains about 1/2 pound a month
Weight at 2 years
quadruples birth weight then gains 4-5 lbs per year
Weight at 9-10 years
increased weight gain with puberty approaching ~ 10 lbs a year.
Height at 2-3 years
grows ~ 3 1/2 inches a year. Most children double birth-length by 3-4 y.o.
Height 3 years to pubery
grows about 2 inches per year
Greenstick Fx
One side of the bone but not all the way through.
Bending or Bowing (Fx)
Plastic deformation, no actual Fx, the bone is just deformed.
Bucle (torus) Fx
The bone is stressed in a way that you don’t get actual Fx but an upheavel of the bone.
Motor skills at 28 mo
jump off floor with both feet
Motor skills at 34 mo
jumps from 12 in height - both feet
Progression of difficulty - JUMPS
down from 1 foot to other
up from 2 feet to 2 feet
down from 2 feet to 2 feet
Run and jump forward from one foot to other
Jump forward from 2 feet to 2 feet
Jump over object from 2 feet to 2 feet
* most early jumps are vertical, tend to keep legs tucked rather than extending them to help with push off, 3-5 inches per year in horizontal distance and 2 per year in vertical height in the elementary years.
Galloping
first asymmetric gait mode, 9-12 mo after walking. Develops after running and before hopping.
Hopping
One foot: few children under 3 can hop repeatedly. develops to age 5. preferred leg before non-preferred.
Skipping
Develops between 4(5)-7 y.o.
Throwing
Overhand first, then underhand. Mostly with forearm.
Catching
Bigger balls, trap against body first, then more arms/scoop with body, then catch with hands (takes a lot of hand/eye coordination)
Bouncing - 2 hands then one, then alternating
2 y.o. kicking
kicks small ball forward
3 y.o. kicking
runs up to ball to kick it
5 y.o. kicking
drop kicks a ball
Developmental coordination disorder
discrete motor disorder under broader heading of neurodevelopmental disorders.
Early developmental period it first shows up.
Must be actually affecting childs’ quality of life.
