Posture 1yr+ Flashcards
define postural control
controlling the body’s position in space
goal of postural control system
stable vertical posture of head/trunk against gravity to provide a base for dynamic activities
COM at birth
xiphoid process
COM in adults
iliac crest, S2-S3
a correction strategy is required when…
COM approaches BOS
static postural control
maintaining COM within BOS
dynamic postural control
governs movement of COM in/out of BOS
righting rxn
orient self to environment
equilibrium rxn
maintain balance when COM disturbed
protective rxn
restore balance if equilibrium cannot
components of postural control
- sensory organization
- eye-head stabilization
- MSK system
- postural sway strategies
- predictive central set
- environmental adaptation
- motor coordination
sensory organization: visual system 0-3yrs
dominates postural responses
sensory organization: visual system 4-6yrs
source of primary info
sensory organization: somatosensory system 7-10yrs
adult-like ability to use somatosensory info for balance
sensory organization: vestibular system 7-10yr
adult-like ability to use vestibular info for balance
continues developing to age 16
eye-head stabilization
using eyes and labyrinths to provide sensory input about movement of surroundings & head
MSK system contributes to postural control by…
body size/proportions
viscoelasticity
muscle tone
postural sway strategies: ankle
small perturbations (thing that disrupts balance) foot fully supported
postural sway strategies: hip
large perturbations
foot not fully supported
postural sway strategies: step
perturbation is too large to recover without a protective step
postural sway strategies: age 4-6
varying strategies used
postural sway strategies: age 7-10
consistent ankle strategy used
predictive central set
postural readiness
predictive central set: feed forward mechanism
anticipatory postural adjustment to prepare for movement and/or assist in movement (by adding force or velocity)
environmental adaptations
changes in posture in response to perceived needs (e.g. walking on something slippery, walking on sand)
motor coordination
The ability to coordinate muscle activation in a sequence that preserves posture.
motor coordination: strategies used
muscle synergies
postural rxns
sway strategies
prerequisites to motor coordination
adequate strength and muscle tone
Periods of rapid increases in bone mineral density
1-4yrs
Puberty
90-95% of peak bone mass before age 20
childhood bone growth is primarily…
LE
adolescent bone growth is primarily…
trunk
adolescent bone growth occurs at age
girls: 12-13yr
boys: 15-17yr
factors affecting bone growth
genetics nutrition hormones physical activity general health status
normal femoral inclination angle
130deg
femoral inclination angle - coxa valga
160deg
femoral inclination angle - coxa vara
105deg
femoral inclination angle at birth
slight coxa valga
femoral inclination angle ____ (increase or decrease) from birth to adulthood
decrease
antetorsion ____ (increase or decrease) from birth to adulthood
decrease
anteversion ____ (increase or decrease) from birth to adulthood
decrease
normal bone growth: load is _____ to growth plate or _____ to direction of growth.
perpendicular to growth plate
parallel to direction of growth
effects of too much/too little load on bone growth
too much load = may interfere with bone growth (Blount’s)
too little load = may not stimulate appropriate bone growth (Hemiplegia)
effects of unequal load on bone growth
change direction of bone growth
ex) limb length discrepancy
effects of torsional load on bone growth
result in rotational changes
e.g. from W-sitting
effects of shearing load on bone growth
displace growth plate (Slipped capital femoral epiphysis)
Blount’s disease: what is it?
progressive growth disorder
deceleration of growth at medial knee
results in tib vara
Blount’s disease: risk factors
obesity
genetics
vit D deficiency
boys > girls
Blount’s disease: clinical presentation
bowing out
limb length discrepancy
abnorm gait
in-toeing (frequent tripping)
Blount’s disease: role of PT
bracing (HKAFO - Hip Knee Ankle Foot Orthosis)
surgery if conservative tx not worked by 4yr.
surgery = better alignment when done before age 4.
surgery = lower re-occurance rate if done after age 4.5
Osgood-Schlatter’s Disease: what is it?
Activity-related knee pain/edema at insertion of patellar tendon.
minor separation of tibial tubercle from tensile force from patellar tendon.
Osgood-Schlatter’s Disease: causes
repetitive strain
trauma
muscle tightness
boys > girls
Osgood-Schlatter’s Disease: role of PT
ice/rest modify activity flexibility (esp quads) neoprene bracing or taping immobilization if severe resolves by age 15 (tubercle fuses)
Legg-Calve-Perthes Disease: what is it?
Abnormal blood supply to femoral head
Avascular necrosis
4-8 years old
Legg-Calve-Perthes Disease: causes
Nutrition delayed bone growth abnormal clotting or venous drainage decreased birth weight boys > girls
Legg-Calve-Perthes Disease: clinical presentation
Muscle weakness
Decreased ROM - hip ABD & IR
gait deviations (Trendelenburg)
pain in groin, hip, knee
Legg-Calve-Perthes Disease: role of PT
Goal: decrease compression on joint, maintain ROM, prevent arthritis.
Mobility, strength, gait.
Legg-Calve-Perthes Disease: conservative treatments
full hip ABD w/ bracing steroids ROM strength NWB if severe.
Legg-Calve-Perthes Disease: surgery treatments
Free Vascularized Fibular Grafting (FVFG)
Proximal Femoral Varus Derotation Osteotomy (VDRO)
NWB
AROM lower leg
Slipped Capital Femoral Epiphysis (SCFE): what is it?
Femoral head displaced posteriorly/inferiorly (in relation to the femoral neck).
Age 10-15.
Boys > girls.
Slipped Capital Femoral Epiphysis (SCFE): causes
mechanical
endocrine
obesity
Slipped Capital Femoral Epiphysis (SCFE): clinical presentation
Acute or chronic pain: groin, medial thigh, knee.
Antalgic Gait
Decreased hip ROM: Flex, ABD, IR, ER noted with hip flexion
Slipped Capital Femoral Epiphysis (SCFE): role of PT
Refer to ortho
Surgery to stabilize growth plate (NWB initially).
PT: strength & gait (as WB allows).
Return to normal activity: 3-6 months
Scoliosis: What is it (& Cobb angle)
Abnormal lateral curvature
Cobb >10 degrees
Infantile scoliosis
<3yr
<1% of cases
idiopathic
resolves spontaneously
Juvenile scoliosis
3-9yr
High rate of progression/severe deformity if untreated
Adolescent scoliosis
80% of cases
Only 3-9% of these cases require interventions
Scoliosis: role of PT
Orthosis: 18-23 hours/day until skeletal maturity.
Exercise
Transfer & gait training
Pain management
Patient education: Bend, Lift, Twist; Backpack management
Muscle mass increase - gender differences
Boys 5x
Girls 3.5x
Strength improvements - prepubescent
improved force output
NOT muscle mass
neuro adaptations
Strength improvements - postpubescent
improved force output
improved muscle mass
Ex rx for kids: ___ reps & ____ resistance
high reps
mod resist
what causes muscle tightness?
Long bone growth exceeds rate muscle lengthens
Metabolic heat dissipated with exercise is _____ (more/less) in kids than adults?
more
T/F: Children acclimate slower to changes in temperature
true
T/F: Children have greater dependence on vasoconstriction
false, children depend more on vasoDILATION
T/F: Sweat rate is higher in kids
false, sweat rate is LOWER in kids than adults
Why is sweat rate lower in kids?
Children have increased density of sweat glands.
Adult gland produces 2.5x more sweat.
How does nervous system development impact motor skills?
ongoing myelination = conduction improves = reduced rxn time (time btwn presentation of stim & motor response)
How does the sensory system become more refined?
Increased abilities to:
attend >1 trait of a stimulus
attach meaning to sensory stimuli
plan motor response
When does the vestibular system reach maturity?
10-14yr
When does the hearing system reach maturity?
13yr
When does the visual system reach it’s best ability?
10yr
