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OTA 140 - Pediatrics > Postural Control, Movement Disorders, Positioning > Flashcards

Postural Control, Movement Disorders, Positioning Flashcards

1
Q

Postural Control Steps that Lead to Skill

A

Child must be MOBILE to move into position, then STABILITY required to maintain position, then MOBILITY IS SUPERIMPOSED ON STABILITY for functional movement/occupational tasks, then SKILL is acquired.

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2
Q

Antigravity Positions

A

Ability to move against gravity with all body parts and in all positions; particularly in prone/supine.
• Shift from lateral to midline movements
• Changes in head/trunk control and extremity movement
• Development of Antigravity positions involves: Mobility; Stability; Mobility superimposed on Stability; Skill
• Assessed in most developmental tests through development of motor milestones such as prone/supine head control

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3
Q

Postural Control

A
  • Change in COG, close to head to close to pelvis with sitting
  • Shift from static stability to dynamic mobility
  • Acquisition of motor milestones
  • Influence of tone vs. strength
  • Develops sequentially—early positions prerequisites for later positions
  • Prone > Supine > Side lying > Sitting > Quadruped > Standing
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4
Q

Postural Reactions

A
  • Righting Reactions (maintain body alignment/balance)
  • Protective Reactions (6 mo.; reactive/compensatory to external disturbances)
  • Equilibrium Reactions (“tilting” reactions help return body to vertical; when supporting surface displaced; essential for purposeful movement/mobility)
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5
Q

Influences on Postural Control

A
  • Nature vs. Nurture: emergence of postural control and motor milestones
  • Sensory systems associated with postural control
  • Emergence of anticipatory postural control
  • Postural sway and muscle activation
  • Tone vs. Strength
  • Other: neuro-motor system; maturation of musculoskeletal system; weight of body segment/movement against gravity
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6
Q

Assessment of Righting Reactions in Postural Control

A
  • Neck on body
  • Body on body
  • Body on head
  • Landau
  • Flexion response
  • Vertical reactions (Labyrinthine, optical righting)
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7
Q

Assessment of Equilibrium Reactions in Postural Control

A
  • Response to displacement in prone/ supine/ sit/ quad/s tand
  • Lateral/ anterior/ posterior/ diagonal
  • Adequate flexibility, muscle strength, experience with postural disturbance are necessary for mature equilibrium response
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8
Q

Assessment of Protective Reactions in Postural Control

A
  • Displacement on tilting surface or manual displacement on stable surface
  • Differ from equilibrium reactions because they are designed to protect from fall
  • Characterized by extension of extremities to “catch” self
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9
Q

Assessment of Neuromotor in Postural Control

A
  • Designed to evaluate emergence and progression of postural reactions and integration of primitive reflexes
  • Emphasis on examining asymmetries in emergence of the reactions
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10
Q

Assessment of Sensory Integration in Postural Control

A
  • Sensory organization
  • Balance (visual/vestibular connection)
  • Bilateral coordination
  • Praxis (ideation, planning, execution)
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11
Q

Assessment of Higher Level Balance Skills in Postural Control

A
  • Gross motor skills testing (B&O, PDMS II)
  • Stance ambulation
  • Ball skills
  • Reaction responses
  • Anticipatory responses
  • Single limb stance
  • Balance beam or heel-toe walking
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12
Q

Assessment of Anticipatory Postural Control

A 
• Clinical Observation
• Difficulty with:
- Reaching
- Catching
- Throwing
- Kicking
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13
Q

What is Seen in Atypical Postural Development

A
  • Persistence of primitive reflexes
  • Abnormal muscle tone, muscle control and force generation
  • Altered sensory function or integration
  • Disorganization of motor response
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14
Q

Intervention for Postural Control

A 
FACILITATION:
• Intrinsic/extrinsic feedback
• Musculoskeletal abnormalities/positioning
• Physical postural support
• Support to increase/decrease tone
DEVELOPMENT:
• Antigravity movement
• Postural changes to support strength development
• Postural reactions
• Sensory organization
• Anticipatory postural control
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15
Q

Postural Control Can Affect:

A
  • Proper breath support
  • Proper/effective positioning for activities
  • Ergonomics/biomechanics
  • Adequate reception of sensory systems
  • Attention/alertness
  • Prevent future risk of injury/illness
  • AND MORE!
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16
Q

Positioning (definition)

A

Child’s ability to maintain postural control while participating in daily activities.

17
Q

Therapeutic Handling

A

Dynamic techniques that guide child’s movements to:
• Influence muscle tone
• Promote postural stability
• Trigger new automatic movement responses

18
Q

Transitional Movements

A

Moving in and out of different positions. Using numerous movements while engaging in daily occupations.

19
Q

Typical Motor Development (stages)

A

1) Physiologic Flexion at birth (passive stretch to extensors of trunk); first voluntary movement is neck extension
2) Head extension in prone position stretches cervical flexors, which preps muscles for activity (head control achieved as infant gains strength/coactivation of cervical flexors/ext.)
3) Long rolling from prone to supine accidentally then purposefully (gains stability in extremities)
4) Propped prone on elbows, then prone on extended arms further elongates thoracic, lumbar, hip flexors; leads to coactivation of antagonists; leads to trunk and hip control
5) Assuming/maintaining variety of positions leads to development of mature movement/motor coordination

20
Q

Considerations for Positioning

A
  • Progression of motor development is necessary to engage in activities
  • Skeletal alignment and symmetry
  • Typical development/appropriate positions
  • Perception and body awareness; sense of self in space from different angles
  • Postural control for balance and functional activity
21
Q

Postural Mechanism

A
  • Muscle tone
  • Postural control and stability
  • Righting responses
  • Equilibrium reactions
  • Protective extension reactions
22
Q

Principles of Positioning as Therapeutic Tool

A
  • Provide variety of options
  • Use positions that enhance function
  • Avoid restricting movements
  • Provide comfortable positions
  • Consider safety
  • Promote skeletal alignment and symmetry
  • Provide proximal stability to promote distal mobility
23
Q

Prone on Elbows and Extended Arms

A

Infant begins stretching hip flexors and developing head control; shifts center of gravity. Facilitate using:
• Wedges
• Rolls
• Bolsters
• Inverted labyrinthine board (kneel standing with weight on belly on extended arms; reflex inhibitive position)

24
Q

Side-Lying

A
  • Promotes coactivation of flexors and extensors
  • Promotes eye-hand regard
  • Promotes hands to midline
  • Facilitate using: Side-lyers; padded benches; rolled towels; pillows
25
Q

Sitting

A
  • Motor control important requisite
  • W-sitting: not recommended over 1 year
  • Facilitate using: Corner chairs; bolster chairs; tires covered with blanket; firm inner tubes
26
Q

Wheelchairs

A
  • Provide positioning and means of mobility to access environment
  • Manual or electric
  • Variety of frames, wheels, armrests, etc.
  • Ultra-light, light, or heavy-duty types
27
Q

Quadruped Position

A

On knees with arms extended
• Requires head and trunk control coupled with shoulder and pelvic stability
• Weight bearing/shifting in all four bases
• Able to reach out with one hand
• Precursor to crawling and creeping (forward movement on belly)
• Facilitate using: Rolls; bolsters; commercially available crawlers

28
Q

Tall Kneel and Half Kneel

A

Prerequisite to standing.
• Tall kneeling easier (larger base of support; half kneeling requires more dissociation of legs/balance)
• Vulnerability of knee joint (avoid prolonged kneeling)
• Use during transitions to/from sitting/standing

29
Q

Standing

A

Full weightbearing through hips and Les
• Promotes bone growth, joint alignment, muscle development, circulation
• Adapted standers available (prone, supine, or free standing)

30
Q

Therapeutic Handling Tips

A
  • Provides dynamic interaction between child, OTP, significant others involved in intervention process
  • Allows OT to feel child’s response to changes and to modify handling as necessary to assist in successful motor responses
  • Adjust proximal/distal key points of control based on motor/sensory response
  • Gentle guidance with respect to skin integrity, irritability, and overall adaptive response
  • Safety and ethical considerations
31
Q

Handling Techniques

A
  • Gentle physical cueing using palm of hand/pads of fingers
  • Directional cueing to encourage weight shifts
  • Stimulation of muscle groups to contract or relax
  • Less cueing used as child gains control
32
Q

Inhibition Techniques in NDT

A
  • Sustained pressure on tendon
  • Slow rocking, rolling or stroking
  • Rotation
  • Weight bearing/shifting
  • Heavy joint compression
  • Wrapping/swaddling
  • Hand vibration
  • Calming environment
33
Q

Facilitation Techniques in NDT

A
  • Light moving touch
  • Tapping, sweep tapping, brush tapping, and/or alternate tapping
  • Fast vestibular input
  • Heavy joint compression
  • Weight bearing/shifting
  • Quick and variable movement
  • Stimulating environment

OTA 140 - Pediatrics (18 decks)

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