Postural Control, Movement Disorders, Positioning Flashcards
Postural Control Steps that Lead to Skill
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.
Antigravity Positions
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
Postural Control
- 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
Postural Reactions
- 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)
Influences on Postural Control
- 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
Assessment of Righting Reactions in Postural Control
- Neck on body
- Body on body
- Body on head
- Landau
- Flexion response
- Vertical reactions (Labyrinthine, optical righting)
Assessment of Equilibrium Reactions in Postural Control
- 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
Assessment of Protective Reactions in Postural Control
- 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
Assessment of Neuromotor in Postural Control
- Designed to evaluate emergence and progression of postural reactions and integration of primitive reflexes
- Emphasis on examining asymmetries in emergence of the reactions
Assessment of Sensory Integration in Postural Control
- Sensory organization
- Balance (visual/vestibular connection)
- Bilateral coordination
- Praxis (ideation, planning, execution)
Assessment of Higher Level Balance Skills in Postural Control
- 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
Assessment of Anticipatory Postural Control
• Clinical Observation • Difficulty with: - Reaching - Catching - Throwing - Kicking
What is Seen in Atypical Postural Development
- Persistence of primitive reflexes
- Abnormal muscle tone, muscle control and force generation
- Altered sensory function or integration
- Disorganization of motor response
Intervention for Postural Control
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
Postural Control Can Affect:
- 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!
Positioning (definition)
Child’s ability to maintain postural control while participating in daily activities.
Therapeutic Handling
Dynamic techniques that guide child’s movements to:
• Influence muscle tone
• Promote postural stability
• Trigger new automatic movement responses
Transitional Movements
Moving in and out of different positions. Using numerous movements while engaging in daily occupations.
Typical Motor Development (stages)
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
Considerations for Positioning
- 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
Postural Mechanism
- Muscle tone
- Postural control and stability
- Righting responses
- Equilibrium reactions
- Protective extension reactions
Principles of Positioning as Therapeutic Tool
- 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
Prone on Elbows and Extended Arms
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)
Side-Lying
- Promotes coactivation of flexors and extensors
- Promotes eye-hand regard
- Promotes hands to midline
- Facilitate using: Side-lyers; padded benches; rolled towels; pillows
Sitting
- Motor control important requisite
- W-sitting: not recommended over 1 year
- Facilitate using: Corner chairs; bolster chairs; tires covered with blanket; firm inner tubes
Wheelchairs
- 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
Quadruped Position
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
Tall Kneel and Half Kneel
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
Standing
Full weightbearing through hips and Les
• Promotes bone growth, joint alignment, muscle development, circulation
• Adapted standers available (prone, supine, or free standing)
Therapeutic Handling Tips
- 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
Handling Techniques
- 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
Inhibition Techniques in NDT
- Sustained pressure on tendon
- Slow rocking, rolling or stroking
- Rotation
- Weight bearing/shifting
- Heavy joint compression
- Wrapping/swaddling
- Hand vibration
- Calming environment
Facilitation Techniques in NDT
- 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
