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Neuro Rehab 1 > Postural Control and Gait Development > Flashcards

Postural Control and Gait Development Flashcards

1
Q

what are the 3 components of balance? what are the 3 subcategories of each component?

A
  1. individual
    - motor
    - sensory
    - cognitive
  2. environment
    - support surfaces
    - cognitive load
    - sensory context
  3. postural tasks
    - steady state
    - proactive
    - reactive
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2
Q

what are the three components contributing to posture

A

task
individual
environment

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3
Q

what are 6 components of an individual that will contribute to their postural systems

A

MSK
cognitive resources
cognitive strategies
sensory organization
sensory systems
ms synergies

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4
Q

what is balance

A

interplay b/w postural control/tasks and individual and environment

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5
Q

development of postural control reflects changes in… (2)

A

strength
mass of body segments
- body proportions

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6
Q

development of postural control reflects development of what postural control components (5)

A
  1. NM responses
  2. sensory systems
  3. sensory strategies for organization of balance
  4. internal representation (perception to action)
  5. adaptive and anticipatory mechanisms
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7
Q

1mo milestone

A

lifting head

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8
Q

4-7mo milestones

A

sitting w support
–> sitting independently

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9
Q

8-10mo milestone

A

creeping
–> crawling

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10
Q

at what age is the milestone of pulling to stand achieved

A

9-10mo

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11
Q

12-13mo milestone

A

independent stance

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12
Q

14-18mo milestone

A

walking

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13
Q

what are 3 theoretical frameworks

A

dynamic systems & ecological
neuronal group selection
perception-action

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14
Q

what is dynamic systems and ecological theories

A

organization of elements w/i postural control system is shaped by task & environment

  • development is non-linear bc of variations in postural control system and how individual is creating that
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15
Q

how does dynamic systems and ecological theories define motor behavior

A

self-organization of body systems to find best solution to task

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16
Q

neuronal group selection theory: variation vs variability

A

both are normal

variation = broad repertoire of behaviors for motor function

variability = capacity to select strategy that best suits situation

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17
Q

what are the phases of neuronal group selection theory

A

lots of variation in motor behavior; little adaptability
->->->
ability to select best motor strategy for task d/t active experience/trial & error; adaptable

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18
Q

according to neuronal group selection theory, what makes the broad repertoire of motor function behaviors more selective

A

interaction b/w genetics and experiences and innate abilities

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19
Q

what does the neuronal group selection theory say

A

ability to adapt to environment demands is shaped by the never-ending interaction b/w experience and genetic info

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20
Q

how can neuronal group selection theory be applied to working with children with movement dysfunction

A

need to provide opportunities for environment interaction and help them perceive the need for adaptability to achieve goal

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21
Q

what does the perception-action framework state

A

perception guides action & action “turns up” perceptual info

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22
Q

what are affordances as applicable to the perception-action framework

A

opportunities in environment to move

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23
Q

how does the perception-action framework define development

A

changes in bodies, perceptual skills, movement/action system

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24
Q

what is the process of development as defined by the perception- action framework

A

development -> changes in percepiton/action loop -> learning/development

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25
Q

what are 3 categories of early reflexes and reactions

A
  1. attitudinal/primitive reflexes
  2. righting reactions
  3. equilibrium & protective reactions
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26
Q

what does the hierarchal reflex theory of motor control say and how does this differ from contemporary theories

A

HIERARCHAL - CNS controls movement
- as matures goes from reflexive movement to more mature righting and equilibrium reactions for balance

CONTEMPORARY - CNS plays a role in development but not only main contributor

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27
Q

where are attitudinal/primitive reflexes mediated at

A

SC and brainstem

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28
Q

what are attitudinal/primitive reflexes

A

automatic, predicted motor pattern
not necessarily contributing to movement but first seen

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29
Q

where are righting reactions mediated at

A

midbrain

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30
Q

how are righting reactions used as an early strategy

A

response to mild perturbation
- initiates movement against gravity

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31
Q

where are equilibrium and protective reactions mediated at

A

cortex/higher centers

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32
Q

how are equilibrium and protective reactions utilized as an early strategy

A

response to mod-max perturbations
- keeps COG/COM w/i BOS

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33
Q

what are two attitudinal reflexes and what triggers them in general

A
  • symmetric tonic neck (STNR)
  • asymmetric tonic neck (ATNR)

reflexes changes body position based off where head is

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34
Q

what is the STNR and what triggers it

A

symmetric tonic neck reflex
triggered by head flex or ext

if head flex, UE flex and LE ext
if head ext, UE ext and LE flex

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35
Q

what is the ATNR and what triggers it

A

asymmetric tonic neck reflex
triggered by head rotation

head rotation will cause ipsi ext of UE and LE and contra flex of UE and LE
- fencing pose

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36
Q

what are 5 righting reactions

A

optical
labyrinthine
body on head
landau
neck on body

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37
Q

what is the optical righting reaction stimulated by

A

visual input

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38
Q

what is the labyrinthine righting reaction stimulated by

A

vestibular

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39
Q

what is the body on head righting reaction stimulated by

A

somatosensory

40
Q

what is the landau righting reaction stimulated by

A

somatosensory

41
Q

what is the neck on body righting reaction stimulated by

A

neck afferents

42
Q

what do righting reflexes contribute to

A

postural control development

43
Q

what does optical righting reaction look like

A

visual input from environment helps them adjust their head against gravity to be in line with the horizon
- ex: if holding sitting baby and tilt their body, their head will correct
- ex: visual input from a blanket or parent will help prone infant lift head up

44
Q

describe the labrynthine righting reaction

A

when vision is occluded, vestib system is responsible for righting
- not having somatosensory info coming in from a surface

45
Q

describe BOH righting reaction

A

receive somatosensory input from surface (ie table)
- ex: if moved (blind folded) prone infant to edge of table, would sense there isn’t more table and would lift head and upper trunk up

46
Q

what is the testing position for the landau righting reaction

A

suspending them horizontally in air

47
Q

what is a (+) Landau righting reaction

A

baby can hold superman position
- ext legs, head, trunk

48
Q

what is the corresponding skill to a (+) Landau and when is this skill usually seen

A

prone ext
often seen when excited

49
Q

what are the righting reactions NOB and BOB triggered by and what are their purposes

A

have to do w orientation of body to itself and getting body back into alignment

50
Q

what is the NOB righting reaction

A

neck on body
- when passively rotating infant’s head, instead of triggering an automatic attitudinal response, see trunk roll like a log so that head, neck, trunk, and extremities all stay in alignment

51
Q

what is the BOB righting reaction

A

body on body
- more mature reaction
- same realignment w more trunk rotation

52
Q

what is the goal of equilibrium reactions

A

keep COM within BOS

53
Q

what are 4 equilibrium reactions and when do you see them

A
  1. tilting - moving surface
  2. postural fixation - withstand external perturbations
  3. protective reactions - ant, lat, post
  4. staggering/stepping
54
Q

how is transitional movement initiated

A

weight shift (WS)

55
Q

what is the possible responses to a weight shift in a transitional movement

A

righting/equilibrium response
LOB

WS leads to postural response

56
Q

what shapes the weight shift needed for a transitional movement and the response to that weight shift

A

individual, task, and environment
practice -> skill acquisition

57
Q

what is the cephalocaudal direction of control

A

head control before trunk control

58
Q

what is the progression of where postural control strategies/righting & equilibrium reactions are seen

A

prone/supine
then sitting
then standing

59
Q

what is the progression of rolling and when in development (3)

A

~4mo - prone to supine
~6-8mo - supine to prone
~9mo - log roll -> segmental

60
Q

what is the prone progression from birth to 10-13mo (5)

A

head life
prone on elbows (POE)
prone on hands (POH)
quadruped
creeping

61
Q

when is static sitting achieved

A

~6-8mo

62
Q

what are the 4 stages as static sitting develops

A
  1. no control of large sway
  2. attempts to initiate upright
  3. partial control w large range body sway
    - ring sitting w arms propped in front, what happens if lift arms up
  4. functional control w minimal sway
63
Q

what is influencing the development of static sitting (4)

A

development of righting and equilibrium reactions
gains in strength
practice
opportunity

64
Q

how does a child get from supine to stand early on and later (under the age of 2)

A

early on: roll to prone -> quadruped -> pull/push to stand

later: prone -> quadruped -> plantigrade -> stand

65
Q

how does a child 2-3yo look going from supine to stand

A

modified roll & sit up -> stand

66
Q

how does a child 4-5yo look going form supine to stand

A

symmetrical sit up pattern

67
Q

what task is evidence of reactive and anticipatory postural adjustments once child can do it

A

pull to stand

68
Q

when and where are reactive postural adjustments seen in infants and children (5)

A

7-8mo - ankle strategies in pull to stand

10-12mo - gross distal to prox motor coordination

3mo of walking - staggering/stepping responses

4-6yo - variability & adaptability of patterns

7-10yo - adult-like reactive adjustments

69
Q

when and where are anticipatory postural adjustments seen in infants and children (4)

A

10-13mo - gastroc activity (to counteract motion of arms)

16-17mo - more consistent & temporally specific

3-5yo - variable APA (immature -> adult-like)

4-6yo - adult like APA

70
Q

key ages of sensory integration for balance

A

4-6yo - transitional period for ability to resolve sensory conflicts using adult-like sensory integration strategies

adolescence - maturation of visual, somatosensory, vestib systems, & ability to solve sensory conflict

71
Q

why are children 4-6yo usually clumsier than they have been

A

transitioning to use less vision for balance and more strategies for movement

72
Q

how is visual input critical when it comes to balance

A

critical for calibrating and modulating b/w somatosensory and vestib input

73
Q

what role does visual input play in postural reactions of infants

A

elicits organized postural reactions in standing in infants at an earlier age than somatosensory does in the presence of conflict

rely on visual system for sensory conflict

74
Q

what role do vestib and somatosensory input play in postural control and balance

A

vestib - when vision is occluded, input on postural orientation

somatosensory - important for limb position and orientation

75
Q

what are the 3 requirements for gait

A
  1. PROGRESSION: rhythmic stepping pattern
  2. STABILITY: strength + postural control
  3. ADAPTATION: to environmental changes
76
Q

what are prenatal origins of gait (2)

A

~9wks gestation = isolated leg and arm movement

~16wks gestation = alternating leg movements

77
Q

what is the sequence and order of limb movement and coordination prenatally

A

cephalocaudal sequence
- forelimbs -> hindlimbs

INTRAlimb -> INTERlimb coordination

78
Q

why can’t newborns walk if there are prenatal origins to gait

A

immature postural control system and strength limitations against new role of gravity

79
Q

what is the innate central pattern generator (CPG)

A

basic rhythm of step cycle
- seen in automatic (or neonatal) stepping reflex where feet move in reciprocal stepping pattern

80
Q

where is the CPG located

A

below brainstem level

81
Q

what is astasia-abasia

A

dancing feet
not reflexive movement of feet to take steps - much more inconsistent

82
Q

when is neonatal stepping seen developmentally

A

appears newborn and “disappears” ab 2mo

83
Q

according to the dynamic systems perspective, why does astasia-abasia disappear after 2mo

A

body build changes doesn’t match strength requirements
- changes in wt, length, mass

early maturation of descending pathways -> control of locomotor activity w/i 1st year

84
Q

how is adaptation seen in gait

A

ability to step over, avoid obstacles

85
Q

what is gait adaptation influenced by

A

reactive & proactive balance responses

86
Q

what are 3 ways that gait adaptations are different in infants and young children compared to adults

A
  1. takes longer to change locomotor pattern prior to obstacle avoidance
  2. use vision to guide pattern change
  3. 1st use proactive movement of head and trunk to steer, then use reactive adjustments (step length, width) just before avoidance
87
Q

what are 4 characteristics of the stance phase of gait in early walkers

A
  1. PF @IC
  2. flex knee
  3. absent push off motion
  4. force generation -> forward trunk lean
88
Q

what position are the arms usually seen in early walkers and why

A

in high guard
- can help slow down if lot of momentum

89
Q

what does the step width and temporal characteristics of gait look like in early walkers

A

wide step width

high cadence
low velocity
short swing phase d/t diminished SLS

90
Q

what are 4 characteristics of the swing phase of gait in early walkers

A

dec DF
inc hip flex
pelvic tilt
hip ADD

91
Q

what age is a child considered an early walker

A

~9-15mo

92
Q

what are characteristics of the hip in gait for later walkers

A

dec pelvic tilt
ABD
ER

93
Q

what age is a child to be considered a later walker

A

~2yo

94
Q

what are 3 characteristics of gait in later walkers

A
  1. (+) knee flex wave
  2. push off by end of 2yo
  3. reciprocal arm swing, but UE post to trunk
95
Q

what is a spatial characteristic of gait that will be different in later walkers than early walkers

A

narrower BOS in later walkers

96
Q

how does gait develop from later walkers on

A

3yo - mature gait pattern
refinement by 7yo

97
Q

how will gait change as it is refined from later walkers on (4)

A

SLS
step and stride side lengths
velocity
cadence

Neuro Rehab 1 (27 decks)

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