Normal Motor Development

Question 1

What are the theories of motor development?

Answer 1

Neuromaturational theory, dynamic systems theory, neuronal group selection theory

Question 2

What is a central pattern generator?

Answer 2

CPG; neural networks that can produce rhythmic patterned outputs without rhythmic sensory or central input. (Underlie walking, chewing, infantile kicking, etc)

Question 3

Primary tenets of the neuromaturational theory

Answer 3

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

Question 4

Pediatric physical therapy initially developed according to which model?

Answer 4

Neuromaturational

Question 5

What are primitive reflexes?

Answer 5

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.

Question 6

What theory is the basis for current pediatric physical therapy?

Answer 6

Dynamic Systems Theory

Question 7

Basic tenets of dynamic systems theory

Answer 7

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

Question 8

Basic tenets of neuronal group selection theory

Answer 8

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.

Question 9

3 requirements for neuronal group selection

Answer 9

basic repertoire of movement
availability of sensory information to identify and select adaptive forms of movement
means to strengthen the preferred movement response.s

Question 10

What is a central pattern generator?

Answer 10

neural networks that produce rhythmic patterned outputs without rhythmic sensory or central input. (walking chewing infantile kicking)

Question 11

Who had the behavioral perspective?

Answer 11

Skinner

Question 12

What is the behavioral perspective?

Answer 12

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

Question 13

Who had the theory of cognitive development?

Answer 13

Piaget

Question 14

What is the theory of cognitive development?

Answer 14

emphasizes an interaction between maturation of cognitive-neural structures and environmental opportunities to promote action. 4 stages

Question 15

What are the 4 stages of the theory of cognitive development?

Answer 15

Sensorimotor
Pre-operational
Period of concrete operations
Formal operations

Question 16

What was the impact of the Piagetian theory on pediatric physical therapy?

Answer 16

Primarily the inclusion of problem solving activities in therapeutic programs to assist in the cognitive-motivational aspect of facilitating motor development

Question 17

What is the sensorimotor stage

Answer 17

birth-2 yr: child learns through sensory and motor experiences, discoveries by trial and error, repetition of activities is important at this stage.

Question 18

What is the pre-operational stage

Answer 18

2-6 years: child begins to use symbols, development of language. Things seem very real.

Question 19

What is the period of concreete operations stage

Answer 19

7-11 years: develops ability to classify objects according to characteristics - child can solve concrete problems in the here and now

Question 20

What is the formal operations stage

Answer 20

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.

Question 21

What are the areas of development that assessments try to evaluate?

Answer 21

social/emotional, language/communication, cognitive, motor

Question 22

Neonate motor development

Answer 22

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.

Question 23

What is the neonate breathing rate?

Answer 23

40-60 breaths per minute

Question 24

One month motor development

Answer 24

reduced physiologic flexion, pelvis may be down/flat, hands tend to be fisted

Question 25

Two month motor development

Answer 25

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.

Question 26

What are astasia and abasia?

Answer 26

motor incoordination for standing/walking

Question 27

Three month motor development

Answer 27

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

Question 28

What is an indicator of motor problems at three months?

Answer 28

Inability to hold the head in midline or persistence of strong asymmetry.

Question 29

What is the respiratory rate of a 3 mo old?

Answer 29

Decreases to 30-50 breaths per minute between 3-6 months

Question 30

Month four is the month of ______

Answer 30

strong symmetry

Question 31

Four month motor development

Answer 31

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

Question 32

Five month motor development

Answer 32

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

Question 33

Six month motor development

Answer 33

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.

Question 34

What is required to roll SUPINE TO PRONE

Answer 34

body righting on body, ATNR inhibited for segmental rolling

Question 35

Seven month motor development

Answer 35

prone is preferred position, may begin to belly crawl, STNR

Question 36

Eight month motor development

Answer 36

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.

Question 37

Nine month motor development

Answer 37

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.

Question 38

What are some warning signs at nine months?

Answer 38

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.

Question 39

10 month motor development

Answer 39

lower self from standing, increased LE control, stand with 1 HHA, walks with 2 HHA, mama/dada specific, learn to wave bye bye

Question 40

11 month motor development

Answer 40

use LE to rise to standing maybe from squat position, able to stand alone briefly, about the time they will say another word.

Question 41

12 month motor development

Answer 41

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

Question 42

What are some concerns at 12 months?

Answer 42

Not crawling with forward movement, or if they seem to be losing skills.

Question 43

15 month motor development

Answer 43

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

Question 44

18 month motor development

Answer 44

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

Question 45

Other movements you may see

Answer 45

W sit, hitching, bunny hopping, bear standing.

Question 46

2 y.o. important milestones

Answer 46

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)

Question 47

3 y.o. important milestones

Answer 47

up/down stairs alternating steps, pedals tricycle, 4-5 word sentences, can be mostly understood by strangers, can take turns, toilet training (2-3)

Question 48

4 y.o. important milestones

Answer 48

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

Question 49

5 y.o. important milestones

Answer 49

able to hop, do a somersault, some skip, count 10 or more objects, knows name and address, established hand dominance

Question 50

Weight in the first year

Answer 50

triples birth weight, then gains about 1/2 pound a month

Question 51

Weight at 2 years

Answer 51

quadruples birth weight then gains 4-5 lbs per year

Question 52

Weight at 9-10 years

Answer 52

increased weight gain with puberty approaching ~ 10 lbs a year.

Question 53

Height at 2-3 years

Answer 53

grows ~ 3 1/2 inches a year. Most children double birth-length by 3-4 y.o.

Question 54

Height 3 years to pubery

Answer 54

grows about 2 inches per year

Question 55

Greenstick Fx

Answer 55

One side of the bone but not all the way through.

Question 56

Bending or Bowing (Fx)

Answer 56

Plastic deformation, no actual Fx, the bone is just deformed.

Question 57

Bucle (torus) Fx

Answer 57

The bone is stressed in a way that you don't get actual Fx but an upheavel of the bone.

Question 58

Motor skills at 28 mo

Answer 58

jump off floor with both feet

Question 59

Motor skills at 34 mo

Answer 59

jumps from 12 in height - both feet

Question 60

Progression of difficulty - JUMPS

Answer 60

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.

Question 61

Galloping

Answer 61

first asymmetric gait mode, 9-12 mo after walking. Develops after running and before hopping.

Question 62

Hopping

Answer 62

One foot: few children under 3 can hop repeatedly. develops to age 5. preferred leg before non-preferred.

Question 63

Skipping

Answer 63

Develops between 4(5)-7 y.o.

Question 64

Throwing

Answer 64

Overhand first, then underhand. Mostly with forearm.

Question 65

Catching

Answer 65

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

Question 66

2 y.o. kicking

Answer 66

kicks small ball forward

Question 67

3 y.o. kicking

Answer 67

runs up to ball to kick it

Question 68

5 y.o. kicking

Answer 68

drop kicks a ball

Question 69

Developmental coordination disorder

Answer 69

discrete motor disorder under broader heading of neurodevelopmental disorders. Early developmental period it first shows up. Must be actually affecting childs' quality of life.