Peds Flashcards
Novel skills emerge from ___________ of child with tasks and environment
interaction
____________ develops simultaneously with ____________, and is functionally linked to these tasks from the start
postural control
mobility and manipulative skills
development of postural control is ________ for development of independent mobility, reaching, etc…
essential
development of postural control is due to interactions in several systems including: (6)
1 - changes in msk system (biomech, growth/anthro)
2 - develop motor strategies/neuromuscular synergies
3 - develop sensory systems
4 - develop sensory strategies for organizing multiple inputs
5 - develop internal mapping
6 - develop adaptive and anticipatory mechanisms
postural control in each position is ______ based on child’s experience and ___________ in that position
learned
active, task-oriented practice
in each position, infant gradually learns to control newly added _______ and _________ in that position to their own action
DOF
maps sensory perception
Newborns have poor head control due to lack of ________________ but some innate abilities exist
strength and organized muscle activity
newborns produce graded and appropriate response to _________ and _________ of visual flow
direction and velocity
new borns develop ___________ at 2 months (& _______ holding of head with added visual stimulus
vestibular antigravity responses
stronger
innate abilities exist, but infants need ______ and ________ for visual/postural coupling
experience
self-produced movements
Early sitters ____ DOF. With experience, gradually ______ for increased variability and adaptability
freeze
free DOF
T or F muscle synergies (in response to perturbations) are present at 1 month
true but not reliable
muscle synergies are present at 1 mth but more complete responses once…
independent sitting is achieved at 7 mth
- need experience and movement in this position
anticipatory motor control is present at _______ but by 9 months infants activate…
3months
postural muscles consistently in advance of reach most of the time
infants with little sitting experience have _________ in the moving room. With increased sitting experience, responses become modulated as child learns to __________________
complete LOB
map visual sensory info into their postural activity
infants initially rely heavily on _____ for postural control
vision
T or F if you take away vision, 0-3 yo. somatosensory and vestibular system cannot elicit a response
F, they can. These systems are available early on but not preferred
with _____ and _____ infants more often show complete postural responses they can modulate more appropriately
practice
experience
What are some big differences with standing vs sitting?
smaller BOS
unfreeze DOF
COM higher
diff perception of world/more environment to explore
Why does postural control in sitting get worse as standing balance emerges?
recalibrating sensorimotor maps for postural control
exploratory vs performatory sway
explore - new position boundaries
perf - occurs during task
Where is COM for kids vs adults?
T12 kids L4-5 adults
T or F: muscle strength is the rate limiting factor for early stance aquisition
F, kids need to build synergies from distal ankle up during pull-to-stand months
sway _______ is adult-like by 9-12 y eyes open, 12-15 y eyes closed
sway ____ is adult-like by 12-15 years
amplitude
velocity
compared to adults, reactive muscle responses are ____________, causing compensatory postural adjustments that………
variable and slower
last longer and produce greater amplitude sway
As early as _____ children have anticipatory responses for movement. When are they adult like?
10 month
4-6 years old
What will happen if children only have vestibular information for postural control?
they’ll fall
when can children reweight to solve sensory conflicts
10 years old
Young children (4-6 y.o. shower greater deterioration of performance in ___________ vs older children (7-13 y.o)
dual task
children 4-11 yrs swayed ___ when cog task was more __________
less
difficult/engaging
individuals with CP will fall ______ than typically developing peers
more often
postural control deficits = ________ deficits
mobility
What is the big issue with the “crouched” posture (due to limited ROM) that kids with CP display?
crouched posture, even in TD children results in significant co-activation of muscles in response to perturbation
can alignment alone influence what strategies are effective and how muscles are recruited?
absolutely, think kids with cp
Children with CP and TD wearing solid AFOs demonstrated…
- decrease use of ankle strategy
- delayed onset or no ankle muscle activity
- increase use of hip and trunk muscles
AFO study suggests available ROM has a significant impact on ________ and _________ of muscles used for postural control
timing
sequencing
postural sway is greater in _____- and more _______ in some children with CP vs TD peers
amplitude
“regular”
is “regular” postural sway a good thing for kids with CP?
no. Increased regularity means decreased automaticity for postural control and decreased adaptability
Providing _______ improved sway amplitude and regularity in kids with CP
concurrent visual feedback
what are two sequencing problems that kids with CP experience
- reversal in muscle recruitment (proc to distal)
- coactivation of agonists/antagonists
is coactivation an efficient response to perturbation
nope
is reflex excitability (spasticity) the primary impairement for delayed activation of postural responses?
no, regruitment and regulation of firing frequency may be the primary impairment
children with CP have difficulty __________ of in response to varying perturbations
scaling amplitude
Do kids with CP activate postural muscles in advance of voluntary movement?
no
Do children with CP have primary sensory impairments?
yes, especially vision
children with CP have difficulty with sensory ______ and __________
selection and reweighting
when SS was unreliable, children with CP were _____________ compared to TD peers without vision and with unreliable vision
more unstable (swayed more, faster LOB)
_______ interference contributes significantly to postural instability in children with CP
dual task
children with CP were significantly ____________ on secondary task when in narrow vs wide stance condition
less accurate
individuals with DS have __________ of falls throughout their lifespand
increase risk
What are 2 MSK impairments individuals with DS experience
hypotonia
hypermobility/joint laxity
what are two reactive motor coordination probs those with DS experience
-delayed recruitment of proximal synergists leads to excessive motion at knee and hip
- coactivation of agonist/antagonist
stretch reflex responses in those with DS are the same as TD, thus postural control differences are not due to _________
hypotonia and delayed DTR itself
T or F those with DS often do not activate or don’t activate enough postural muscle in advance of voluntary movements
T
those with DS have sensory _______ probs
selection
those with DS are unable to ____________ responses to changing task situations
adapt/attenuate
