Pediatric Development Flashcards
Pediatric PT
Peds PT provide screening, evulation, habilitation, and rehabilitation, and preventive services to infants, children, and youths, up to the age of 21, as well as provide support to childrens families
HABilitation = skil was never acquired before
- skill they do not have but are new training pt to get it for the first time
ex. children w/ DD learning to walevaluation
Goal of pediatric physical therapy?
Optimize participation
- Games, playing > motor development, social skills, communication & cognitive skils (tactics & strategies)
- There is an increasing effort to provide PT in the child’s environment
Shift to how children can live with their disability, impairment, &/or health condition && on how they, and their families can be helped to achieve a productive, fulfilling life
Essentially, INC participation in their daily lives
APGAR
Description
Test to quickly evaluate and summarize a newborn’s health, physical condition, and the need for immediate care - MAIN function
APGAR score is given once at 1 minute after birth, and again at 5 minutes after birth
- if the score @ 5 mins is LOW OR there are concerns regarding the baby’s condition, the APGAR is scored again at 10 minutes
APGAR Total Score
Total Score: 0-10
- Severely depressed: 0-3
- Moderately depressed: 4-6
- Excellent condition: 7-10
Low score = infant requires medical attention (ie ventilation)
APGAR scores that remain low after 10 minutes have an increased risk for neurological complications
- Correlated but not the purpose
When does Ventilatory Maturity occur?
Impact?
What is considered pre-mature?
Ventilatory maturity @ 32 weeks
** Big factor is good production of surfactant (Type II alveolar cells)
= substance that helps with DEC surface tension b/t alveoli = DEC chance of collapse (atelectasis)
Low or no surfactant (immature lung) =
Infant Repiratory Distress Syndrome (IRDS) or
Neo-natal Distress Syndrome
Pre-mature = <36 weeks
APGAR Scoring System
(5)
- Activity (mm tone)
- Pulse (heart rate)
- Grimance (reflex irritability)
- Appearance (skin colour)
- Respiration (breathing rate & effort)
Pg. 344 for complete chart - study
Preterm Birth
Decription & Gestational Age
Birth of a viable infant that occurs at fewer than 37 weeks of gestation
** Preterm birth in comination with low-birth weight significantly increases the risk for neurological impairments
Gestational Age:
- Extremely preterm: < 28 weeks
- Very preterm: 28-32
- Moderate-late preterm: 32-37
- Term birth: 37 weeks (typically 38-41)
Adjusted Age
Definition
A perterm child’s corrected age is based on a 40-week gestation timeline (term birth).
- CA = subtract child’s chronological age (weeks since birth) by the number of weeks the child was born prematurely (number of weeks born prior to 40-weeks)
Corrected age will be the age in which you should actually compare the child’s development
The child will gradually catch up to the typical skill levels of children born at term, usually by the age of 2 in the absence of any impairments
Neonatal Reflexes
Definition & Types
A relfex is an involvuntary response to a stimulus
“primary” or “primitive” reflexes are reflexes which appear during the neonatal period & become INTEGRATED by the end of infancy
- Higher center controls take over that reflect & it becomes VOLUNTARY > child then has voluntary control over that mvmt
Presistence of reflexes beyond their normal time frames may interfere with achievement of developmental milestones
- ex. persistent ATNR would prevent a child from being able to roll = cannot dissassociate mvmts
Reflex: Asymmetrical Tonic Neck Reflex
Onset - Integration - Stimulus - Response
Onset:
- 20 weeks gestation
Integration:
- 5 months
Stimulus:
- Turning head
Response:
- Extension of UE & LE on the side the face is turned too
- Contralateral = flexion UE & LE
Reflex: Rooting
Onset - Integration - Stimulus - Response
Onset
- 28 weeks gestation
Inegration:
- 3 months
Stimulus
- Lightly storking perioral areas (around mouth)
- Useful b/c they have poor vision
Response:
- Movement of head & lips toward side of stimulus
- Important for breast feeding
Reflex: Suck-Swallow
Onset - Integration - Stimulus - Response
Onset
- 28 weeks gestation
Integration
- 5 months
Stimulus:
- Touch to inside mouth (programmed)
Response:
- Rhythmic sucking and swallowing
Reflex: Palmer Grasp
Onset - Integration - Stimulus - Response
Onset:
- 28 weeks gestation
Integration
- 7 months
Stimulus:
- Pressure against palm of hand
Response:
- Flexion of fingers
Reflex: Flexor Withdrawal
Onset - Integration - Stimulus - Response
Onset
- 28 weeks gestation
Integration
- 2 months
Stimulus
- Noxious stimulus to bottom of foot
Response:
- Extension of toes, ankle DF, hip & knee flexion on stimulus side
Reflex: Crossed Extension
Onset - Integration - Stimulus - Response
Onset
- 28 weeks gestation
Integration:
- 2 months (inconsistent)
Stimulus:
- Noxious stimulus to bottom of foot
Response:
- Flexion of LE on stimulus side
- Extension & adduction of LE of contralateral side
** Holding baby up while other leg is flexed
Occurs @ the same time as the flexor withdrawal reflex
Reflex: Galant (trunk incurvation)
Onset - Integration - Stimulus - Response
Onset:
- 28 weeks gestation
Integrated:
- 3 months (inconsistent)
Stimulus:
- Stroke paravertebral skin while in prone
Response:
- Incurving of trunk towards stimulated side
Reflex: Moro
Onset - Integration - Stimulus - Response
Onset:
- 28 week gestation
Integration:
- 5 months
Stimulus:
- Sudden head drop backwards
Response:
- Extension & abduction of UE w/ opening of hands & crying
- May be followed by flexion & adduction of UE
Precrusor to later motor development
Reflex: Positive Support
Onset - Integration - Stimulus - Response
Onset
- 35 weeks gestation
Integration:
- 2 months (inconsistent)
Stimulus:
- Feet in contact with floor or firm surface
Response:
- Bilateral leg extension to support weight
Precrusors to later motor development
Reflex: Stepping
Onset - Integration - Stimulus - Response
Precrusor for starting to walk
Onset
- 37 weeks gestation
Integrated:
- 4 months
Stimulus:
- Supported upright (vertical) with feet in contact with firm surface - MUST be supported
Response:
- Rhythmic high stepping movement
Reflex: Landau
Onset - Integration - Stimulus - Response
Onset:
- 4-5 months after full-term delivery
Integrated:
- 24 months (2 years)
Stimulus:
- Suppported in prone with hands under thorax
Response:
- Head, neck, nack, and LE EXTENSION
“Superman pose”
Reflex: Symmetrical Tonic Neck Reflx (STNR)
Onset - Integration - Stimulus - Response
Onset:
- 4-6 months after full-term delivery
Integrated:
- 12 months
Stimulus:
- Flexion or extension of C/S
Response:
- C/S flexion causes UE Flexion & LE Extension
- C/S extension causes US extension & LE flexion
Arms will follow head mvmt & legs are opposite
Normal Gross Motor Development
(10) + Age of Acquistion
Roll (prone > supine FIRST) = 3-6 months
Sit (independent) = 6 months
Crawl = 8-9 months
Cruising = 9 months
Standing = 9 months
Walking = 10-15 months (wider window)
Stair Climbing (step-to-pattern) = 18-20 months
Running = 2 yearrs
Kick a ball = 3 years
Skipping = 5 years
Head control = 4 months
Common DEVELOPMENTAL Scales
(4) Names & Ages & Skills
Alberta Infant Motor Scale (AIMS)
- 0-18 months
- Motor skills
Bayley Scales of Infant Development - 3rd edition (BSID)
- 1-42 months
- Mental, motor, and behaviour scale
Peabody Developmental Motor Scale - 2nd edition (PDMS-2)
- 0-60 months (5 years)
- Fine & Gross motor skills
Bruininks-Oseretsky Tests for Motor Performance, 2nd edition (BOT-2)
- 4-21 years (5-14 in some texts)
- Fine & Gross motor skills
- Can test and document longitudinal impact of conditions on motor function
** Can be used as baseline & over the entire course of the child’s development
Alberta Infant Motor Scale (AIMS): Description
Appropriate for infants 0-18 months old
Standardized & norm-referenced motor development assessment tool
Observational & performance based - standardized postions the child is put in & then observe what the child does in those positions > want to seee typical things @ nomral developmental age
- Examine, discriminate, and evaluate infants’ spontaneous movements
- Evaluate changes over time - testing trhoughout development
Screen infants for motor delays
- identifiy infants that require early intervention
- Help direct interventions if PTs are seeing specific milestones that the child is NOT reaching…
